Table 4.

Documentation of reasons for withholding anticoagulation for high-risk patients with atrial fibrillation and flutter discharged home from the emergency department (n=227).

	N (%)
Reasons for withholding anticoagulation
Not documented	88 (38.8)
Documented	139 (61.2)
Physician concerns*	86 (37.9)
Bleed risk (including fall risk)	29 (12.8)†
Defer decision to outpatient physician	23 (10.1)
Restoration of sinus rhythm has reduced risk	19 (8.4)
Assents with another physician’s recommendation (either in prior notes or during consultation)	15 (6.6)
Perceived to be low risk for stroke, independent of sinus rhythm	6 (2.6)
Already on LMWH or non-aspirin antiplatelet agent	3 (1.3)
Patient concerns*	60 (43.2)
Prefers to discuss further with outpatient provider	20 (8.8)
Declines anticoagulation, no explanation documented	20 (8.8)
Previously discontinued‡	10 (4.4)
Perceived bleed risk	7 (3.0)
Frequent phlebotomy required	3 (1.3)

LMWH, low molecular weight heparin.

^*Percentage calculated from cases in which the reason for withholding anticoagulation was documented (n=139). Seven cases included documentation of both physician and patient concerns.

^†In 15 of these 29 cases the physician specified that their concern was the risk of falling.

^‡Reasons for previous discontinuation of warfarin were documented in six cases and included intolerance (n=2), bleeding or easy bruising (n=2), allergy (n=1), and non-adherence (n=1).