Use of Anticoagulation Therapy in Patients With Perioperative Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Meta-analysis

Wang, Michael Ke; Heo, Rachel; Meyre, Pascal; Park, Louis; Blum, Steffen; McIntyre, William F.; Belley‐Côté, Emilie P.; Birchenough, Lauren; Vuong, Kiven; Healey, Jeff S.; Devereaux, P.J.; Lamy, André; Conen, David

doi:10.1016/j.cjco.2022.06.003

Cited by 6 publications

(2 citation statements)

References 32 publications

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“…Whereas the ESC/EACTS guidelines ( 20 ) recommend a rate-control approach in asymptomatic POAF patients, the Canadian Cardiovascular Society (CCS) ( 21 ) recommends POAF treatment with either a rate-control or a rhythm-control approach, and the ACC/AHA guidelines do not specifically address the topic. The efficacy of various interventions is summarized in Table 2 ( 19 , 27 , 30 , 33 , 38 , 39 , 48 , 52 , 62 , 63 , 68 , 75 , 76 ).…”

Section: Management Of Postoperative Afmentioning

confidence: 99%

“…In a systematic review and meta-analysis of nine observational trials and 254,200 patients, Wang and colleagues found that the short-term absolute risk (AR) reduction for thromboembolism was 0.8% (95% CI: 0.4–1.4, NNT =125), with a long-term AR reduction of two events per 1,000 person-years ( 75 ). Patients on OAC were three times more likely to have a bleeding event (RR =3.22).…”

Section: Management Of Postoperative Afmentioning

confidence: 99%

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Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review

Suero,

Ali,

Barron

et al. 2024

J Thorac Dis

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Postoperative atrial fibrillation (POAF) after cardiac surgery is associated with elevated morbidity and mortality. Although current prediction models have limited efficacy, several perioperative interventions can reduce patients’ risk of POAF. These begin with preoperative medications, including beta-blockers and amiodarone. Moreover, patients should be screened for preexisting atrial fibrillation (AF) so that concomitant surgical ablation and left atrial appendage occlusion can be performed in appropriate candidates. Intraoperative interventions such as posterior pericardiectomy can reduce mediastinal fluid accumulation, which is a trigger for POAF. Furthermore, many preventive strategies for POAF are implemented in the immediate postoperative period. Initiating beta-blockers, amiodarone, or both is reasonable for most patients. Overdrive atrial pacing, colchicine, and steroids have been used by some, although the evidence base is less robust. For patients with POAF, rate-control and rhythm-control strategies have comparable outcomes. Decision-making regarding anticoagulation should recognize that the stroke risk associated with POAF appears to be lower than that for general nonvalvular AF. The evidence that oral anticoagulation reduces stroke risk is less clear for POAF patients than for patients with general nonvalvular AF. Given that POAF tends to be shorter-lived and is associated with greater bleeding risks in the perioperative period, decisions regarding anticoagulation should be individualized. Finally, wearable technology and machine learning algorithms for better predicting and managing POAF appear to be coming soon. These technologies and a comprehensive clinical program could meaningfully reduce the incidence of this common complication.

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