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

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 2009 and 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.