Outcomes of Anticoagulation Initiation in Critically Ill Patients with New-Onset Atrial Fibrillation: A Multicenter Retrospective Cohort Study
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Introduction: New-onset atrial fibrillation (NOAF) in intensive care units (ICU) carries a high risk of recurrence and atrial fibrillation (AF) related complications. However, evidence on the safety of anticoagulation (AC) in critically ill patients with NOAF is limited. This study aimed to evaluate the impact of AC initiation on clinical outcomes in this population. Methods A multicentre, retrospective cohort study was conducted across four hospitals in Saudi Arabia from January 1, 2018, to February 28, 2024. Adult ICU patients (≥ 18 years) with documented NOAF were included and categorized into two groups: those who received anticoagulation (AC group) and those who did not (non-AC group). The Study outcomes were the incidence of bleeding or thrombotic events during a 1-year follow-up. Results A total of 179 patients were included, with 52.5% in the AC group and 47.4% in the non-AC group. The mean age was 68.1 ± 13.4 years. The median CHA2DS2-VASc and HAS-BLED scores were 3 [2–4] and 2 [2–4], respectively. The mean APACHE II score was significantly lower in the AC group compared to the non-AC group (19.1 ± 6.8 vs. 23.8 ± 9.4; P = 0.0002). The incidence of bleeding events was similar between groups (21.3% vs. 21.2%; P = 0.9869), as was the incidence of thrombotic events (2.1% vs. 5.9%; P = 0.2592). Conclusions In critically ill patients with NOAF, anticoagulation did not significantly alter the risk of bleeding or thrombotic events within 1 year of follow-up. These findings highlight the need for further prospective studies to guide anticoagulation decisions in this high-risk population.