New-onset atrial fibrillation provoked by sepsis: anticoagulate or not?
Your elderly patient with sepsis develops new-onset atrial fibrillation that spontaneously converts to normal sinus rhythm. Should long-term anticoagulation be prescribed at discharge? No good data exist to guide this decision, but a vignette in NEJM provides a closer look at the arguments for and against initiation of a direct oral anticoagulant (DOAC) in this scenario.
Yes, anticoagulate: Post-discharge recurrence of atrial fibrillation detected during sepsis is high (~40% at one year), and stroke risk might be similar as patients with AF identified otherwise. CHA2DS2-VASc scores >0 (for men) or >1 (for women) should prompt initiation of anticoagulation, along with holistic cardiovascular management using the Atrial fibrillation Better Care (ABC) pathway.
No, don’t anticoagulate: Patients with new-onset AF during sepsis were excluded from clinical trials; almost no data is available to inform about their relative risks from stroke vs. bleeding while taking DOACs. A majority (~60%) wi…
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