Should anticoagulants be initiated in patients with sepsis-induced new-onset atrial fibrillation? Best evidence topic report

A focused literature review assessed whether starting therapeutic anticoagulation (AC) during or soon after hospitalisation for sepsis-induced new-onset atrial fibrillation (AF) affects stroke or bleeding risk. Four observational studies were identified. None demonstrated a significant reduction in stroke risk with AC, and one large study found a paradoxical increase in stroke among patients taking anticoagulants. Bleeding risk was not consistently increased, and one study reported reduced mortality with AC. Overall, current evidence does not support the routine use of AC for stroke prevention in patients with sepsis-induced new-onset AF. A randomised controlled trial is needed to clarify the role of AC in this population.