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Published on: February 28, 2012
Comparison of Anticoagulants for Postoperative Atrial Fibrillation After Coronary Artery Bypass Grafting: A Pilot
Todd W Chapin1, David D Leedahl1, Andrew B Brown2
1Pharmacy Services, 23506Sanford Health, Fargo, ND, USA.
Insights
Direct-acting oral anticoagulants like apixaban show promise for treating atrial fibrillation after cardiac surgery. This pilot study found apixaban to be safe, effective, and less expensive than warfarin, including monitoring costs.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Direct-acting oral anticoagulants (DOACs) are standard for nonvalvular atrial fibrillation.
- Their use post-cardiac surgery is unclear despite high rates of postoperative atrial fibrillation (POAF).
Purpose of the Study:
- To evaluate the safety, efficacy, and economic outcomes of apixaban versus warfarin for POAF after cardiac surgery.
Main Methods:
- Prospective randomized pilot study comparing apixaban and warfarin in patients with POAF.
- Outcomes assessed up to 4-6 weeks post-surgery, including safety, efficacy, and costs.
Main Results:
- Adverse event rates were comparable to existing literature.
- Apixaban therapy was significantly less costly than warfarin, considering medication, bridging, and laboratory expenses.
Conclusions:
- Both apixaban and warfarin appear safe and effective for anticoagulation in POAF post-coronary artery bypass grafting.
- Apixaban demonstrated significant cost savings when monitoring and bridging expenses were included.
Background:
Direct-acting oral anticoagulants are indicated for the treatment of nonvalvular atrial fibrillation, but their use in patients after undergoing cardiac surgery is poorly defined despite a high prevalence of postoperative atrial fibrillation in this population.
Methods:
Patients diagnosed with postoperative atrial fibrillation were prospectively randomized to warfarin or apixaban. Safety, efficacy, and economic outcomes were evaluated until their 4- to 6-week postoperative appointment.
Results:
While this pilot study was not powered to determine a difference in safety or efficacy, adverse event rates were similar to the published literature. It was noted that a patient's course of therapy when utilizing apixaban was significantly less costly than warfarin when including medication, bridging, and laboratory expenses.
Conclusion:
Apixaban and warfarin both appeared to be safe and effective for anticoagulation throughout the duration of this pilot study in treating postoperative atrial fibrillation after coronary artery bypass grafting. Apixaban was associated with significantly less expense when bridging and monitoring costs were included in addition to medication expense.
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