Among patients with advanced CKD and ESRD, the use of apixaban was associated with lower risk of major bleeding compared to warfarin, and was found to be relatively effective with no excess risk of thromboembolic events.

AIMTo assess prevalence of pre-existing atrial fibrillation (AF) and/or incidence of AF following liver transplantation, and the trends of patient’s outcomes overtime; to evaluate impact of pre-existing AF and post-operative AF on patient outcomes following liver transplantation.METHODSA literature search was conducted utilizing MEDLINE, EMBASE and Cochrane Database from inception through March 2018. We included studies that reported: (1) prevalence of pre-existing AF or incidence of AF following liver transplantation; or (2) outcomes of liver transplant recipients with AF. Effect estimates from the individual study were extracted and combined utilizing random-effect, generic inverse variance method of DerSimonian and Laird. The protocol for this meta-analysis is registered with PROSPERO (International Prospective Register of Systematic Reviews, No. CRD42018093644).RESULTSTwelve observational studies with a total of 38586 liver transplant patients were enrolled. Overall, the pooled estimated prevalence of pre-existing AF in patients undergoing liver transplantation was 5.4% (95%CI: 4.9%-5.9%) and pooled estimated incidence of AF following liver transplantation was 8.5% (95%CI: 5.2%-13.6%). Meta-regression analyses were performed and showed no significant correlations between year of study and either prevalence of pre-existing AF (P = 0.08) or post-operative AF after liver transplantation (P = 0.54). The pooled OR of mortality among liver transplant recipients with pre-existing AF was 2.34 (2 studies; 95%CI: 1.10-5.00). In addition, pre-existing AF is associated with postoperative cardiovascular complications among liver transplant recipients (3 studies; OR: 5.15, 95%CI: 2.67-9.92, I2 = 64%). With limited studies, two studies suggested significant association between new-onset AF and poor clinical outcomes including mortality, cerebrovascular events, post-transplant acute kidney injury, and increased risk of graft failure among liver transplant recipients (P < 0.05).CONCLUSIONThe overall estimated prevalence of pre-existing AF and incidence of AF following liver transplantation are 5.4% and 8.5%, respectively. Incidence of AF following liver transplant does not seem to decrease overtime. Pre-existing AF and new-onset AF are potentially associated with poor clinical outcomes post liver transplantation.

Objective: Previous studies have suggested a high incidence of atrial fibrillation (AF) in heart transplant recipients. However, incidence trends of AF in heart transplant recipients remain unclear. The study's aims were (1) to investigate the pooled incidence/incidence trends of AF following heart transplantation and (2) to assess the mortality risk of heart transplant recipients with AF. Methods:A literature search for studies that reported the incidence of AF following heart transplantation was conducted using MEDLINE, EMBASE, and The Cochrane Database from inception through March 2018. Pooled incidence and odds ratios (OR) with 95%CI were calculated using a random-effects model. Results:Eighteen studies (2 cohorts from clinical trials and 16 cohort studies) with 5393 heart transplant recipients were enrolled. The pooled estimated incidence of AF in heart transplant was 10.1% (95%CI: 7.6%-13.2%). Meta-analysis based on the type of anastomotic technique demonstrated a pooled estimated incidence of AF following heart transplantation of 18.7% (95%CI: 10.3%-31.5%) and 11.1% (95%CI: 6.5%-18.4%) by biatrial and bicaval techniques, respectively.There was a significant association between AF following a heart transplant and increased mortality risk with a pooled OR of 2.86 (95%CI: 2.08-3.93). Meta-regression analyses showed no significant correlations between the year of study and incidence of AF (P = 0.47) or mortality risk of AF after heart transplantation (P = 0.99). Conclusions:The overall estimated incidence of AF following heart transplantation is 10.1%.There is a significant association between AF and increased mortality after transplantation. Furthermore, incidence and mortality risk of AF following heart transplant does not seem to decrease over time. K E Y W O R D Satrial fibrillation, cardiac, heart, meta-analysis, transplant, transplantation is almost 90% with a median survival rate over 10 years. [2][3][4]

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BackgroundThere are controversial data regarding the relationship between bariatric surgery and atrial fibrillation (AF). This meta‐analysis was performed to evaluate (i) the incidence and (ii) the risk of AF in patients following bariatric surgery.AimsTo explore the incidence and risk factors of AF in patients after bariatric surgery.MethodsA literature search was conducted utilising MEDLINE, EMBASE and Cochrane Database from inception through March 2019. We included studies that evaluated the (i) incidence and (ii) risk of AF in patients after bariatric surgery. Pooled incidence and odds ratios (OR) with 95% confidence interval (CI) were calculated using random effects meta‐analysis.ResultsSeven cohort studies consisting of 7681 patients undergoing bariatric surgery were enrolled in this systematic review. The prevalence of AF in patients undergoing bariatric surgery ranged between 0% and 4.6%. Overall, the pooled estimated incidence of AF following bariatric surgery was 5.3% (95% CI: 1.9–13.8) at a median follow‐up time of 7.9 years (interquartile range (IQR) 4.1–15.0 years). Compared to controls, the pooled OR of AF among patients undergoing bariatric surgery was 0.42 (95% CI: 0.22–0.83) at a median follow‐up time of 7.9 years (IQR 7.2–19.0 years). Egger regression test demonstrated no significant publication bias in our meta‐analysis of AF incidence following bariatric surgery.ConclusionThe overall estimated incidence of AF following bariatric surgery was 5.3%. Our study demonstrates a significant beneficial association between bariatric surgery and AF, with a 0.42‐fold decreased risk of AF. Future large‐scale studies are needed to confirm the potential benefits of bariatric surgery on risk of AF.

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