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Introduction: Oral anticoagulation (OAC) can reduce stroke and mortality risk in patients with atrial fibrillation (AF); however, clinical outcomes associated with OAC prescription after a US emergency department (ED) discharge are unknown. Objective: To determine the impact of early OAC prescribing on ischemic stroke and major bleeding after ED evaluation for AF. Methods: This retrospective study included Medicare, fee-for-service patients (age ≥65yrs) discharged from the ED in 2011-2012 with newly diagnosed actionable AF— high-stroke risk (by CHA2DS2-VASc) with low-bleeding risk (by HAS-BLED), and no OAC prescription filled 90 days prior. Patients were stratified as receipt of an early OAC prescription (by any provider) within 10 days of ED diagnosis and no early OAC. Ischemic strokes were identified via ICD-9 codes from inpatient claims. Major bleeding was identified using prior validated algorithms by ICD-9 diagnosis with requirement of admission. A blanking period of 10 days was used to exclude patients who were in the process of having an ischemic stroke at the index visit. Time to ischemic stroke and major bleeding in patients with actionable AF were compared using Kaplan Meier curves and a Cox proportional hazards model with propensity score weights and a correction for clustering on facility. Results: Of 3,983 with new actionable AF, 25.4% were prescribed an early OAC, who were similar in mean age (77.4 vs. 78.2 yrs) and co-morbidities (mean Charlson score 2.1 vs. 2.3) to no early OAC group, but less likely to be female (69.4% vs. 76.3%) (p<0.001). Patients were followed for a median of 330 days with a maximum of 640 days. Among patients with actionable AF, there were no differences in hazards of ischemic stroke [HR 0.67(0.33-1.40)] nor major bleed [HR 1.45 (0.91-2.30)] (p>0.05) between the early vs. no OAC groups. However, KM curves suggest a trend towards fewer events among patients with early OACs, especially early in follow-up after ED visit. Conclusion: In patients with a new ED diagnosis of actionable AF, early OAC did not statistically affect clinical outcomes. However, there may be a clinically meaningful difference among those prescribed. Large and prospective studies are needed to elucidate the impact of early OAC prescribing on clinical outcomes. [ABSTRACT FROM AUTHOR]