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Updated: Aug 8, 2025

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Practice Patterns and Outcomes Associated With Anticoagulation Use Following Sepsis Hospitalizations With New-Onset

Allan J Walkey1, Laura C Myers2,3, Khanh K Thai3

  • 1Section of Pulmonary, Allergy, Critical Care, Department of Medicine, Boston University School of Medicine, MA (A.J.W., Y.D.).

Circulation. Cardiovascular Quality and Outcomes
|February 28, 2023
PubMed
Summary

Oral anticoagulation use after sepsis-induced new-onset atrial fibrillation (AF) was infrequent. This treatment was linked to a higher risk of stroke or transient ischemic attack (TIA), emphasizing the need for further research.

Keywords:
arrhythmiascardiachumansprobabilitysepsistelemetry

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Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Pharmacology

Background:

  • New-onset atrial fibrillation (AF) during sepsis is a growing concern.
  • Understanding practice patterns for oral anticoagulation (OA) in these patients is crucial for preventing arterial thromboembolism.
  • Current data on OA use and its outcomes following sepsis-associated AF are limited.

Purpose of the Study:

  • To investigate the practice patterns of oral anticoagulation (OA) for arterial thromboembolism prevention in patients with new-onset atrial fibrillation (AF) during sepsis.
  • To evaluate the outcomes, including ischemic stroke/transient ischemic attack (TIA) and major bleeding, associated with OA use in this patient population.
  • To provide evidence for optimizing anticoagulation strategies after sepsis hospitalization.

Main Methods:

  • A retrospective, observational cohort study was conducted on patients aged 40 years or older discharged alive after hospitalization with new-onset AF during sepsis.
  • Data were collected from 21 hospitals within the Kaiser Permanente Northern California health care delivery system between 2011 and 2018.
  • Marginal structural models using inverse probability weighting and Super Learning were employed to estimate adjusted risk differences for outcomes within 1 year of discharge.

Main Results:

  • Of 82,748 sepsis patients, 3,992 (4.8%) developed new-onset AF and survived hospitalization.
  • Only 20% of eligible patients received oral anticoagulation within 30 days of discharge.
  • OA use was associated with a higher adjusted risk of ischemic stroke/TIA (3.37% difference) but not major bleeding within 1 year.

Conclusions:

  • Oral anticoagulation use following new-onset AF during sepsis hospitalization is uncommon.
  • Current OA use appears associated with an increased risk of stroke/TIA.
  • Further research is needed to elucidate stroke/TIA mechanisms and guide management of AF post-sepsis.