New onset postoperative atrial fibrillation and early anticoagulation after cardiac surgery

Maaroos, Martin; Pohjantähti‐Maaroos, Hanna; Halonen, Jari; Vähämetsä, Juha; Turtiainen, Johanna; Rantonen, Juha; Hakala, Tapio; Mennander, Ari; Hartikainen, Juha

doi:10.1080/14017431.2017.1385836

Cited by 13 publications

(12 citation statements)

References 24 publications

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“…16 POAF is an important clinical complication, and it is associated with and approximately 44% higher risk of mortality within 30 days, and even short episodes of POAF may be an indication of therapeutic anticoagulation. 17,18 In our review, the risk of POAF was reduced in the antioxidant treatment group (18% vs 28%), which correlates well with the findings of Shi et al, but we must acknowledge the very low quality of evidence of this outcome and lack of data to ensure reliable findings.…”

Section: Relation To Other Reviewssupporting

confidence: 85%

Antioxidant treatment to reduce mortality and serious adverse events in adult surgical patients: A systematic review with meta‐analysis and trial sequential analysis

Pedersen

Fabritius

Kongebro

et al. 2020

Acta Anaesthesiol Scand

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Background Hyperoxia during anesthesia can increase cellular oxidative stress, and perioperative antioxidant treatment may reduce the resulting damage. The aim of this review was to evaluate risks and benefits of antioxidant treatment in surgical patients. We hypothesized that antioxidant treatment reduced mortality compared to placebo/no intervention. Methods This systematic review with meta‐analyses and trial sequential analysis (TSA) was conducted using Cochrane standards and GRADE methodology. Randomized clinical trials comparing perioperative antioxidant treatment vs. placebo/no intervention in adults were included. Primary outcome was mortality at longest follow‐up. Results Ninety‐seven trials with 8156 patients were included. The most common interventions were N‐Acetylcysteine (36 trials) and vitamin C (29 trials). Trials were primarily performed during cardiac surgery (53 trials). Fifty‐six trials with 4890 patients reported information on mortality (243 events). The meta‐analysis of mortality at longest follow‐up showed a reduced mortality in antioxidant treated patients (RR 0.74, 95% CI 0.59; 0.94, I2 0%), however, TSA‐adjusted CI was broadened (0.55‐1.02) and only 31% of the required information size was reached. Furthermore, in the subgroup of three trials with overall low risk of bias the RR for mortality was 1.18 (95% CI 0.39, 3.63). Based on GRADE, our findings are of low quality of evidence due to high risk of bias, imprecision, and indirectness. Conclusion We found a 26% relative risk reduction of mortality in surgical patients treated with antioxidants but the quality of evidence supporting our findings is low and influenced by clinical heterogeneity and high risk of systematic‐ and random errors.

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Section: Relation To Other Reviewssupporting

confidence: 85%

Antioxidant treatment to reduce mortality and serious adverse events in adult surgical patients: A systematic review with meta‐analysis and trial sequential analysis

Pedersen

Fabritius

Kongebro

et al. 2020

Acta Anaesthesiol Scand

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“…The optimal anticoagulation duration for patients with elevated thromboembolic risk theoretically depends on the risk of recurrence. However, CS‐POAF strongly predicts late AF (adjusted odds ratios: 3.5–8.3) 12,13,17–19,22 …”

Section: Discussionmentioning

confidence: 99%

Anticoagulation management of postoperative atrial fibrillation after cardiac surgery: A systematic review

et al. 2021

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Background Postoperative atrial fibrillation (POAF) often complicates cardiac surgery and is associated with increased mortality and risk of thromboembolism. However, the optimal oral anticoagulation (OAC) strategy is uncertain. We performed a systematic review to examine the OAC practice patterns and efficacy in these circumstances. Methods MEDLINE and EMBASE were searched from 2000 to 2019 using the search terms cardiac surgical procedures, cardiac surgery, postoperative complications, atrial fibrillation, atrial flutter, and terms for anticoagulants. Collected data included anticoagulation patterns (time of initiation, type, and duration) and outcomes (stroke, bleeding, and mortality). Results From 763 records, 4 prospective and 13 retrospective studies were included totaling 44,908 patients with 8929 (19.9%) who developed POAF. Anticoagulation rates ranged from 4% to 43% (mean 21% overall). Sixteen studies used warfarin, 3 nonvitamin K OAC (NOAC), and 2 both. Four studies reported the use of bridging unfractionated or low‐molecular‐weight heparin. Concomitant antiplatelet therapy was reported in half the studies, ranging from 80% to 99%. OAC use was associated with lower risk of thromboembolic events in two retrospective studies (including a national Danish cohort with 2108 patients with POAF). Patients discharged on warfarin experienced reduced mortality in a large, single center, retrospective analysis, but no association was observed in the Danish cohort. Conclusion There is wide practice variation in the uptake, timing of initiation, duration, and choice of OAC for POAF following cardiac surgery. The evidence is largely retrospective and insufficient to assess the efficacy of different OAC strategies. Further studies are warranted to guide clinical practice.

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“…Each patient analyzed in the studies was found to have POAF for at least 24 hours duration. The exceptions were the Maaroos study and the Glotzer study, where patients with POAF were found to have POAF for at least 5 minutes and 6 minutes, respectively [11,12]. Most of our patients in this study included post cardiac surgery patients, either post coronary artery bypass graft or post valvular surgery [11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…The exceptions were the Maaroos study and the Glotzer study, where patients with POAF were found to have POAF for at least 5 minutes and 6 minutes, respectively [11,12]. Most of our patients in this study included post cardiac surgery patients, either post coronary artery bypass graft or post valvular surgery [11][12][13][14]. The exceptions were the Makhija and Butt studies, which studied patients involved in non-cardiac surgery [10,15].…”

Section: Discussionmentioning

confidence: 99%

A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?

Ibrahim¹,

Kulkarni²,

Botchway³

et al. 2020

JICOA

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Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on whether these patients would benefit from chronic anticoagulation. Objective: To assess whether patients with POAF benefit from chronic anticoagulation. Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of ischemic stroke, and mortality. Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant differences found in mortality outcomes between POAF patients that received anticoagulation as compared to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857, P = 0.5447). Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further prospective studies into the question of length of POAF and how chronic anticoagulation therapy plays a role in decreasing risks of ischemic stroke and/or mortality.

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New onset postoperative atrial fibrillation and early anticoagulation after cardiac surgery

Abstract: POAF after cardiac surgery was associated with high risk of MACE. Early anticoagulation may be justified in POAF patients to secure a long-term outcome after cardiac surgery.

Cited by 13 publications

References 24 publications

Antioxidant treatment to reduce mortality and serious adverse events in adult surgical patients: A systematic review with meta‐analysis and trial sequential analysis

Antioxidant treatment to reduce mortality and serious adverse events in adult surgical patients: A systematic review with meta‐analysis and trial sequential analysis

Anticoagulation management of postoperative atrial fibrillation after cardiac surgery: A systematic review

A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?

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