Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients

We investigated real-life oral anticoagulation (OAC) treatment after surgical ablation and examined its adherence to current recommendations. We also explored factors related to OAC use preoperatively and at follow-up.

One hundred and fifteen patients with atrial fibrillation (AF) were evaluated during 12-month follow-up after surgery. Patients were divided into two categories according to the congestive heart failure, hypertension, age ≥75 years, diabetes and prior stroke [or transient ischaemic attack or thromboembolism] (CHADS2) score: 60 patients were assigned to the high-risk group (CHADS2 score ≥2) and 55 to the low-risk group (CHADS2 score ≤1). OAC use was defined as guideline adherent, undertreatment or overtreatment.

Baseline overall guideline adherence was 62%. OAC was underprescribed in high-risk patients and overprescribed in low-risk patients (both, P < 0.001). The only factor associated with OAC use after logistic regression analysis were age >75 years (P = 0.01) and preoperative AF > paroxysmal (P = 0.013). Overall guideline adherence at 12-month follow-up showed a trend towards a better adherence in the sinus rhythm (SR) subgroup (74% vs 55%, P = 0.02). OAC was underprescribed in high-risk patients and overprescribed in low-risk patients (both P < 0.001). After logistic regression analysis, preoperative OAC use (P = 0.007) and other indications for OAC (P = 0.01) were predictors of anticoagulation treatment.

Real-life OAC prescription in AF patients showed a moderate guideline adherence, with high-risk patients being undertreated and low-risk patients being overtreated. These findings stress the importance that antithrombotic treatment in patients undergoing AF surgery needs to be critically re-evaluated.