Risk Stratification in Atrial Fibrillation and Observation Unit Entry

Abstract

The most common complication of atrial fibrillation is arterial thromboembolism, which can lead to ischemic stroke. Thus, it is important to determine which patients would benefit from antithrombotic therapy to help lower the risk of thromboembolic events. As detailed in the chapter on anticoagulation therapy, there are various Federal Drug Administration (FDA)-approved options for stroke prevention in atrial fibrillation that are endorsed by current guidelines. These would include both oral and parenteral treatments, including low-molecular-weight heparin, unfractionated heparin, vitamin K antagonists, direct thrombin inhibitors, and factor Xa inhibitors. The initiation of these medications may occur in the outpatient, emergency department (ED), observation unit (OU), or inpatient setting and will depend on the patient’s presentation and risk for thromboembolic events, which will be discussed in this chapter. Furthermore, risk stratification for entry into the OU will be discussed as a means to identify a select number of patients who may be appropriate for a short hospital stay and continued evaluation and management of atrial fibrillation.