Routine anticoagulation is not indicated for postoperative general thoracic surgical patients with new-onset atrial...

Current guidelines suggest anticoagulation for patients with new-onset atrial fibrillation (AF). Little evidence exists for the risk/benefit ratio in postoperative general thoracic surgical patients. We analyzed new-onset AF in patients after a general thoracic operation to determine the benefit of anticoagulation on prevention of stroke and its impact on postoperative outcome.

New-onset postoperative AF developed in 759 patients (527 men, 237 women) who underwent thoracic surgical procedures between 1994 and 2009. Demographic data, clinical presentation, operative findings, and postoperative outcomes were analyzed.

The median age was 71 years (range, 31 to 92 years). We compared 228 patients anticoagulated for new-onset postoperative AF with 531 non-anticoagulated patients. The anticoagulated group had a higher incidence of male sex, pulmonary hypertension, congestive heart failure, and peripheral vascular disease. Median postoperative hospitalization was 9 days(range, 1 to 306 days) in those not anticoagulated and 11 days (range, 1 to 97 days) in those anticoagulated for AF (p=0.704). Stroke occurred in 0.56% of the non-anticoagulated patients vs 2.2% of the anticoagulated patients (p=0.057). Bleeding occurred in 22 patients (9.7%) who were anticoagulated and in 27 (5.1%) who were not (p=0.009). Anticoagulated patients had a higher incidence of at least one complication other than stroke or bleeding (43.4%) vs non-anticoagulated patients (30.9%; p=0.001). Operative mortality in anticoagulated patients was 3.1% vs 6.6% in patients not anticoagulated (p=0.057).

Anticoagulation did not lower the risk of stroke or transient ischemic attacks in postoperative general thoracic surgery patients with new-onset AF but did increase the incidence of postoperative bleeding and other complications. Patients with new-onset AF after a general thoracic surgical procedure should not be routinely anticoagulated.