RESUMO
OBJECTIVES: To examine the use of warfarin in patients with atrial fibrillation (AF) admitted to hospital because of stroke or transient ischemic attack; and to describe the outcome of AF-associated stroke. DESIGN: Review of the medical records of patients, identified from a prospective registry, admitted from January 1, 1994 through December 31, 1996. SETTING: Tertiary care teaching hospital. RESULTS: AF was present in 92 of 722 (13%) patients at the time of admission. Only eight of 60 (13%) patients with ischemic stroke who were known to be in AF before their stroke were taking warfarin. The in-hospital case-fatality ratio for AF patients was more than double that of patients in sinus rhythm (21% versus 9%, respectively, P=0.001). AF patients were less likely to be discharged home (31% versus 59%, P=0.005). Of the 68 AF patients who survived, 74% left hospital taking warfarin. No warfarin-treated patient experienced intracranial bleeding while in hospital or during follow-up. CONCLUSIONS: Patients with AF had more severe strokes than patients in sinus rhythm. A small proportion of patients with known AF were taking warfarin at the time of hospitalization. Bleeding complications were infrequent. Broader implementation of guidelines for the management of AF is justified to reduce the frequency of stroke in this group of patients.
Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Acidente Vascular Cerebral/complicações , Varfarina/uso terapêutico , Idoso , Fibrilação Atrial/complicações , Estudos de Casos e Controles , Feminino , Mortalidade Hospitalar , Humanos , Ataque Isquêmico Transitório/complicações , Ataque Isquêmico Transitório/prevenção & controle , Masculino , Estudos Prospectivos , Sistema de Registros , Acidente Vascular Cerebral/prevenção & controleRESUMO
In this article we try to determine how frequently emergency physicians (EPs) suspected the diagnosis in acute aortic dissection (AD). In this retrospective descriptive study, we identified all patients with the final diagnosis of AD initially evaluated in 1 of 3 emergency departments (EDs) over a 5-year period. Patients were included if AD was not suspected before ED evaluation. Patients undergoing thoracic aorta imaging as the initial ED study were defined as suspected AD. Forty-three patients totaling 44 presentations were identified. EPs suspected AD in 19 of 44 presentations. EPs suspected AD in 12 of 14 (86%) cases of chest and back pain and in 5 of 11 (45%) of chest pain. Thirteen of 39 (33%) painful presentations involved abdominal pain; EPs suspected AD in 1 of 13 (8%). EPs suspected the diagnosis in 43% of acute AD; location of pain was most predictive of a suspected diagnosis.
