Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?

Kollar, Andras; Lick, Scott D.; Vasquez, Kathleen N.; Conti, Vincent R.

doi:10.1016/j.athoracsur.2006.03.037

Cited by 29 publications

(18 citation statements)

References 31 publications

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“…The use of oral anticoagulation only at the onset of AF has been demonstrated to be inadequate to prevent stroke . Interestingly, oral anticoagulation in patients affected by POAF has been demonstrated to reduce early and late mortality associated with thromboembolic AF sequelae . Therefore, it should be considered in high‐risk group patients (POAF score ≥3) immediately after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

Bedside Tool for Predicting the Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: The POAF Score

Mariscalco¹,

Biancari

Zanobini

et al. 2014

JAHA

141

138

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BackgroundAtrial fibrillation (AF) remains the most common complication after cardiac surgery. The present study aim was to derive an effective bedside tool to predict postoperative AF and its related complications.Methods and ResultsData of 17 262 patients undergoing adult cardiac surgery were retrieved at 3 European university hospitals. A risk score for postoperative AF (POAF score) was derived and validated. In the overall series, 4561 patients (26.4%) developed postoperative AF. In the derivation cohort age, chronic obstructive pulmonary disease, emergency operation, preoperative intra‐aortic balloon pump, left ventricular ejection fraction <30%, estimated glomerular filtration rate <15 mL/min per m2 or dialysis, and any heart valve surgery were independent AF predictors. POAF score was calculated by summing weighting points for each independent AF predictor. According to the prediction model, the incidences of postoperative AF in the derivation cohort were 0, 11.1%; 1, 20.1%; 2, 28.7%; and ≥3, 40.9% (P<0.001), and in the validation cohort they were 0, 13.2%; 1, 19.5%; 2, 29.9%; and ≥3, 42.5% (P<0.001). Patients with a POAF score ≥3, compared with those without arrhythmia, revealed an increased risk of hospital mortality (5.5% versus 3.2%, P=0.001), death after the first postoperative day (5.1% versus 2.6%, P<0.001), cerebrovascular accident (7.8% versus 4.2%, P<0.001), acute kidney injury (15.1% versus 7.1%, P<0.001), renal replacement therapy (3.8% versus 1.4%, P<0.001), and length of hospital stay (mean 13.2 versus 10.2 days, P<0.001).ConclusionsThe POAF score is a simple, accurate bedside tool to predict postoperative AF and its related or accompanying complications.

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Section: Discussionmentioning

confidence: 99%

Bedside Tool for Predicting the Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: The POAF Score

Mariscalco¹,

Biancari

Zanobini

et al. 2014

JAHA

141

138

View full text Add to dashboard Cite

show abstract

“…While AF most often occurs within 2-3 days after surgery, most of these occurrences are self-limited [16,17]. There are many determinants for post-operative AF, including increasing age, male gender, the incidence of right coronary artery stenosis, excessive manipulation of the heart during surgery and electrolyte imbalance.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting

Cao

et al. 2011

J Cardiothorac Surg

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ObjectivesPreventing stroke after coronary artery bypass grafting (CABG) remains a therapeutic goal, due in part to the lack of identifiable risk factors. The aim of this study, accordingly, was to identify risk factors in CABG patients with a previous history of stroke.MethodsPatients with a history of stroke who underwent CABG at Beijing An Zhen hospital from January 2007 to July 2010 were selected (n = 430), and divided into two groups according to the occurrence of postoperative stroke. Pre-operative and post-operative data were retrospectively collected and analyzed by univariate and multivariate logistic regression analyses.ResultsThirty-two patients (7.4%) suffered post-operative stroke. Univariate analysis identified several statistically significant risk factors in the post-operative stroke group, including pre-surgical left ventricular ejection fractions (LVEF) ≤50%, on-pump surgery, post-operative atrial fibrillation (AF), and hypotension. Multivariable analysis identified 4 independent risk factors for recurrent stroke: unstable angina (odds ratio (OR) = 2.95, 95% CI: 1.05-8.28), LVEF ≤50% (OR = 2.77, 95% CI: 1.23-6.27), AF (OR = 4.69, 95% CI: 1.89-11.63), and hypotension (OR = 2.55, 95% CI: 1.07-6.04).ConclusionUnstable angina, LVEF ≤50%, post-operative AF, and post-operative hypotension are independent risk factors of recurrent stroke in CABG patients with a previous history of stroke.

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“…In two studies after CABG no clear benefit of anticoagulation emerged in terms of ischaemic stroke prevention and there was no unequivocal temporal relationship between POAF and ischaemic stroke occurrence. 60,61 By contrast, a Japanese study found a significant ischaemic stroke reduction with early anticoagulation (in combination with an antiplatelet agent) after POAF and a temporal relationship between POAF and ischaemic stroke occurrence. 62 One observational study found no benefit of anticoagulation with warfarin in patients who had POAF after general thoracic surgery, but most patients had low CHADS2 scores in this population and consequently event rates were low.…”

Section: Antithrombotic Regimens After Cardiac and Non-cardiac Surgerymentioning

confidence: 93%

Postoperative atrial fibrillation: Target for stroke prevention?

Thijs

Lemmens

Farouque

et al. 2017

European Stroke Journal

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Purpose: A substantial number of patients without a history of atrial fibrillation who undergo surgery develop one or more episodes of atrial fibrillation in the first few days after the operation. We studied whether postoperative transient atrial fibrillation is a risk factor for future atrial fibrillation, stroke and death. Method: We performed a narrative review of the literature on epidemiology, mechanisms, risk of atrial fibrillation, stroke and death after postoperative atrial fibrillation. We reviewed antithrombotic guidelines on this topic and identified gaps in current management. Findings: Patients with postoperative atrial fibrillation are at high risk of developing atrial fibrillation in the long term. Mortality is also increased. Most, but not all observational studies report a higher risk of stroke. The optimal antithrombotic regimen for patients with postoperative atrial fibrillation has not been defined. The role of lifestyle changes and of surgical occlusion of the left atrial appendage in preventing adverse outcomes after postoperative atrial fibrillation is not established. Conclusion: Further studies are warranted to establish the optimal strategy to prevent adverse long-term outcomes after transient, postoperative atrial fibrillation. KeywordsAtrial fibrillation, stroke, prevention, cardiac surgery, coronary artery disease A substantial number of patients without a history of atrial fibrillation (AF) who undergo surgery develop one or more episodes of AF in the first few days after the operation. This condition is termed postoperative AF or postoperative atrial fibrillation (POAF). Up to 90% of these episodes resolve spontaneously. A widely held belief is that POAF is benign and has no long-term consequences.1-3 However, recent studies indicate that transient POAF is a risk factor for development of future AF, stroke and death up to several years after the procedure. These are the focus of this review.Whether the increased stroke and mortality rates are directly related to thromboembolism due to recurrent AF or a higher baseline cardiovascular risk is not established.Furthermore it is unclear if anticoagulation should be recommended in these patients. The 2016 ESC Guidelines on AF do not provide specific recommendations on type and duration of anticoagulation

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Relationship of Atrial Fibrillation and Stroke After Coronary Artery Bypass Graft Surgery: When is Anticoagulation Indicated?

Cited by 29 publications

References 31 publications

Bedside Tool for Predicting the Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: The POAF Score

Bedside Tool for Predicting the Risk of Postoperative Atrial Fibrillation After Cardiac Surgery: The POAF Score

Risk Factors For Recurrent Stroke After Coronary Artery Bypass Grafting

Postoperative atrial fibrillation: Target for stroke prevention?

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