The increasing burden of atrial fibrillation in acute medical admissions, an opportunity to optimise stroke prevention


Background Atrial fibrillation is a major risk factor for ischaemic stroke. We investigated whether active screening for atrial fibrillation in secondary care, followed by careful evaluation of risk factors and communication to general practitioners from stroke specialists, could increase appropriate anticoagulation prescription.

Stroke prevention in atrial fibrillation

Oral anticoagulation therapy has reduced the risk of ischaemic stroke and improved the outcomes for patients with atrial fibrillation considerably. The emergence of the non-vitamin K oral anticoagulants as alternatives to vitamin K antagonists has significantly changed the practice of stroke prevention in atrial fibrillation. As the main complication with antithrombotic therapy is bleeding, physicians should always balance the risk of ischaemic stroke against intracranial haemorrhage and intervene where appropriate to reduce both risks.

A practical approach to the new oral anticoagulants used for stroke prevention in patients with atrial fibrillation

This review evaluates the research undertaken in the last six years on the use of new oral anticoagulants for stroke prevention in atrial fibrillation and provides evidence-based answers to common clinical questions. Two types of new oral anticoagulants – direct thrombin (IIa) inhibitors, and Xa inhibitors – are currently available. These drugs have similar pharmacokinetics and pharmacodynamics. They are more predictable than, though in many respects comparable to, warfarin. They do not require frequent laboratory tests, nor do they have a narrow therapeutic window.

Organising pneumonia due to dronedarone

Organising pneumonia is one of the responses of the lung to injury and can mimic bacterial pneumonia but importantly it does not respond to antibiotic therapy. We present the case of a 67-year-old male who was diagnosed with organising pneumonia secondary to dronedarone. Drug reactions are a common cause and early identification of the culprit is mandatory to prevent further morbidity and ensure a favourable outcome. On chest radiography there may be fleeting peripheral consolidation, while computed tomography can show a range of stereotyped patterns including perilobular consolidation.

Oral direct inhibitors of coagulation

For the first time in 50 years new oral anticoagulants of proven efficacy and with acceptable safety profiles are available for patients with atrial fibrillation and venous thromboembolism. Here is a brief overview of the benefits and possible disadvantages of using these drugs.

KEYWORDS Dabigatran, rivaroxaban, apixaban, anticoagulation, atrial fibrillation, venous thromboembolism

DECLARATIONS OF INTERESTS No conflicts of interest declared.

A prospective survey of acute hospital admissions with atrial fibrillation in Karachi, Pakistan

Background: There are established differences in cardiovascular disease in different racial groups. Worldwide, the literature regarding the clinical epidemiology of atrial fibrillation (AF) in non-white populations is scarce.

Objectives: To document the clinical epidemiology of AF among hospital admissions to two teaching hospitals in Karachi, Pakistan, over a two-month period and to describe the clinical features and management of these patients.

Subjects: 3,766 acute medical admissions, of whom 245 (6.5%) had AF.