Journal of Thrombosis and Thrombolysis

, Volume 48, Issue 3, pp 394–399 | Cite as

Stroke prophylaxis in critically-ill patients with new-onset atrial fibrillation

  • Robert S. Schoaps
  • Ashley Quintili
  • Anthony Bonavia
  • Zyad J. Carr
  • Erik B. Lehman
  • Thomas Abendroth
  • Kunal KaramchandaniEmail author


Despite a high incidence of new onset atrial fibrillation (NOAF) in critically ill patients and its association with short and long-term incidence of stroke, there is limited data assessing anticoagulation on hospital discharge in these patients. We retrospectively reviewed electronic medical records of all adult patients admitted to non-cardiac ICUs at our institution between January 2009 and March 2016. Patients with NOAF were identified and CHA2DS2-VASc score of ICU survivors was calculated. Prescription of oral anticoagulant therapy on hospital discharge was analyzed. A total of 640 (1.7% [38,708 patients]; 95% CI 1.5%, 1.8%) patients developed NOAF during the study period. CHA2DS2-VASc score was calculated for 615 patients, of which 82.2% had a CHA2DS2-VASc score ≥ 2. Of the 428 eligible patients, only 96 patients (22.4%) were discharged on oral anticoagulant therapy. Patients with a history of congestive heart failure (33.7% vs. 19.7%) and stroke/TIA or other thromboembolic disease (35.9% vs. 18.0%) were more likely to be discharged on an oral anticoagulant. Patients with a higher score were also more likely to be discharged on an oral anticoagulant (OR 1.27; 95% CI 1.10, 1.47). NOAF is common in critically ill patients admitted to non-cardiac ICUs and a significant proportion of these patients have a CHA2DS2-VASc score ≥ 2. However, only a minority of them are discharged on an oral anticoagulant. There is a need to identify ways to improve implementation of effective stroke prophylaxis in these patients.


Atrial fibrillation Stroke prophylaxis CHA2DS2-VASc score New onset atrial fibrillation Oral anticoagulation therapy 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of AnesthesiologyVanderbilt University Medical CenterNashvilleUSA
  2. 2.Department of Anesthesiology & Perioperative MedicinePenn State Health Milton S. Hershey Medical CenterHersheyUSA
  3. 3.Department of PharmacyPenn State Health Milton S. Hershey Medical CenterHersheyUSA
  4. 4.Department of Public Health SciencesPenn State Health Milton S. Hershey Medical CenterHersheyUSA
  5. 5.Center for Quality InnovationPenn State Health Milton S. Hershey Medical CenterHersheyUSA

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