Why did you (and your colleagues) write this paper? What was its main purpose?

ALEXANDRA NELSON

Atrial fibrillation is the most common cardiac arrythmia in critically ill patients and is associated with an increased risk of thromboembolic events and mortality. There is a lack of data assessing the impact of anticoagulation strategies on clinical outcomes for general critical care patients with AF. This study assessed the existing literature to evaluate the effectiveness of anticoagulation strategies used in critical care for AF.

What are the main conclusions? 

ALEXANDRA NELSON

A variety of anticoagulation regimens are currently used to treat critically ill patients with AF. There was an increased incidence of major bleeding events in anticoagulated patients with AF in critical care compared to non-anticoagulated patients. There was no significant difference in the incidence of reported thromboembolic events within studies between patients who did and did not receive anticoagulation. However, the outcomes reported within studies were not standardised, therefore, the generalisability of our results to the general critical care population remains unclear.

What are the paper's implications? - to the public? -to medical professionals?

ALEXANDRA NELSON

There were different definitions of outcome measures within the studies included in this review. Therefore, it is difficult to draw meaningful and valid conclusions regarding events such as bleeding/haemorrhage and thromboembolic events, due to the significant heterogeneity in defining these outcomes.

Are the findings clinically significant? Should the findings change practice?

ALEXANDRA NELSON

We cannot confirm an optimal strategy due to the limited number of available studies, variation in study methodology, differences between patient populations included, and a lack of standardisation of study outcomes. Further high quality studies and well planned randomised trials investigating the effectiveness and safety of anticoagulation in critically ill patients with AF are urgently needed, with standardised outcomes to facilitate comparison and the development of evidence based guidance.