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Published on: February 28, 2012
Indecision in the clinical practice of anticoagulation for brief atrial arrhythmias after cryptogenic stroke
Muhib Khan1, Daniel J Miller, Lonni R Schultz
1Department of Neurology, University of Massachusetts, Worcester, Massachusetts.
Insights
Short atrial fibrillation episodes detected via cardiac monitoring in stroke patients led to varied anticoagulation decisions. Cardiology evaluation significantly influenced treatment, highlighting a need for clearer guidelines on brief arrhythmias.
Area of Science:
- Cardiology
- Neurology
- Clinical Medicine
Background:
- Long-term cardiac monitoring effectively detects paroxysmal atrial fibrillation (PAF) in cryptogenic stroke/TIA patients.
- Many detected PAF episodes are brief, raising questions about appropriate anticoagulation treatment.
- This study investigates clinical decisions regarding anticoagulation for short-duration PAF.
Purpose of the Study:
- To analyze treatment decisions for anticoagulation in patients with short-duration paroxysmal atrial fibrillation.
- To compare anticoagulation rates based on AF episode duration and specialist evaluation.
- To identify disparities in prescribing practices between neurologists and cardiologists.
Main Methods:
- Retrospective analysis of mobile cardiac outpatient telemetry records.
- Inclusion of records from neurologists at a tertiary care institution stroke center (June 2009 - January 2012).
- Categorization of atrial fibrillation episodes as <30 seconds or >=30 seconds.
Main Results:
- 39 patients with atrial fibrillation (AF) were identified; 62% had episodes <30 seconds.
- Among patients without cardiology evaluation, anticoagulation rates were similar for short (<30s) and long (>=30s) AF (90% vs. 83%).
- Among patients with cardiology evaluation, anticoagulation was significantly lower for short AF (43%) compared to long AF (89%).
Conclusions:
- Neurologist and cardiologist prescribing practices for anticoagulation in short AF differ significantly.
- Brief AF episodes (<30 seconds) in stroke patients present treatment indecision.
- Further research is required to define risks and benefits of anticoagulation for brief atrial arrhythmias.
Introduction:
Long-term cardiac monitoring has a substantial yield for paroxysmal atrial fibrillation (PAF) detection in cryptogenic stroke or transient ischemic attack (TIA) patients; however, many of these episodes were brief. We analyzed treatment decisions taken by the clinicians regarding anticoagulation in these short-duration PAF patients.
Methods:
We performed a retrospective analysis on all mobile cardiac outpatient telemetry records between June 2009 and January 2012, initiated by neurologists from a large tertiary care institution stroke center.
Results:
In all, 39 patients were found to have atrial fibrillation (AF), and their records were reviewed. AF episodes were categorized as less than 30 seconds in 24 (62%) patients and 30 seconds or more in 15 (38%) patients. Among the 16 patients without a cardiology evaluation, the rate of anticoagulation was high and did not differ for patients with short AF (90%, 9 of 10) and long AF (83%, 5 of 6) (P>.99). However, among the 23 patients with a cardiology evaluation, the difference in rates of anticoagulation was significant between patients with short AF (43%, 6 of 14) and long AF (89%, 8 of 9) (P=.039).
Conclusion:
Our study demonstrates the differences in anticoagulant prescribing practices between neurologists and cardiologists and the inherent indecision these findings have produced. Further study is needed to better define the risks and benefits associated with anticoagulation of brief episodes of atrial arrhythmias lasting less than 30 seconds in patients with cryptogenic stroke or TIA.
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