In patients with new onset AF in whom anti-coagulation is indicated (CHADS2 score of 3) I usually
- Discuss it with the patient and start injectable anticoagulation from the ED (41%, 11 Votes)
- Discuss it with the patient and start oral anticoagulation from the ED (22%, 6 Votes)
- Let the patient's GP discuss it with the patient and start it (22%, 6 Votes)
- Let the patient's specialist discuss it with the patient and start it (15%, 4 Votes)
Total Voters: 27
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About 63% of respondents would start some form of anti-coagulation from the ED, whilst the remainder would leave the decision to one of the patient’s treating doctors. Although the risk of stroke appears to be highest in the first week after new onset AF, it is not clear whether immediate anti-coagulation reduces this risk. Whilst it would make sense that it would, there are some data that suggest initiation of warfarin might increase early stroke risk, so injectable anticoagulants are probably the best choice from the ED. The role of NOACs in this situation is unknown, but theoretically they should not have an increased early thrombosis risk.