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Published on: February 26, 2013
Postoperative Atrial Fibrillation and Long-Term Risk of Stroke in Patients Undergoing Liver Transplantation
Anoop N Koshy1,2,3, Anees Enyati1, Laurence Weinberg4,2,3
1Department of Cardiology (A.N.K., A.E., H.-C.H., M.H., J.K., H.S.L., O.F., A.W.T.), Austin Health, Melbourne, Victoria, Australia.
Insights
Postoperative atrial fibrillation (POAF) after liver transplantation significantly increases thromboembolic event risk. The CHA2DS2VASc score aids risk stratification, but POAF doesn't predict long-term mortality.
Area of Science:
- Cardiology
- Hepatology
- Transplantation Medicine
Background:
- Postoperative atrial fibrillation (POAF) is a frequent cardiovascular complication after liver transplantation (LT).
- Understanding POAF's impact on subsequent thromboembolic events is crucial for patient management.
Purpose of the Study:
- To investigate the association between POAF and the risk of subsequent thromboembolic events in liver transplant recipients.
- To evaluate the predictive value of POAF and CHA2DS2VASc score for thromboembolic events post-LT.
Main Methods:
- Retrospective cohort study of 461 adult patients undergoing LT between 2010-2018.
- POAF defined as new-onset atrial fibrillation within 30 days post-LT.
- Thromboembolic events (ischemic stroke, systemic embolism) adjudicated by independent physicians.
Main Results:
- POAF occurred in 10.2% of patients, with a median onset of 3 days post-LT.
- Patients with POAF had significantly higher rates of thromboembolic events (17.0% vs 3.1%, P<0.001).
- POAF was an independent predictor of thromboembolic events (HR 8.36), as was CHA2DS2VASc score (HR 1.58).
Conclusions:
- POAF following LT is linked to an 8-fold increased risk of thromboembolic events.
- The CHA2DS2VASc score can aid in stratifying risk for these events.
- Further research is needed to determine if anticoagulation can mitigate this risk.
Background And Purpose:
Postoperative atrial fibrillation (POAF) is the commonest cardiovascular complication following liver transplantation (LT). This study sought to assess a possible association of POAF with subsequent thromboembolic events in patients undergoing LT.
Methods:
A retrospective cohort study of consecutive adults undergoing LT between 2010 and 2018 was undertaken. Patients were classified as POAF if atrial fibrillation (AF) was documented within 30 days of LT without a prior history of AF. Cases of ischemic stroke or systemic embolism were adjudicated by a panel of 2 independent physicians.
Results:
Among the 461 patients included, POAF occurred in 47 (10.2%) a median of 3 days following transplantation. Independent predictors of POAF included advancing age, postoperative sepsis and left atrial enlargement. Over a median follow-up of 4.9 (interquartile range, 2.9-7.2) years, 21 cases of stroke and systemic embolism occurred. Rates of thromboembolic events were significantly higher in patients with POAF (17.0% versus 3.1%; P<0.001). After adjustment, POAF remained a strong independent predictor of thromboembolic events (hazard ratio, 8.36 [95% CI, 2.34-29.79]). Increasing CHA2DS2VASc score was also an independent predictor of thromboembolic events (hazard ratio, 1.58 [95% CI, 1.02-2.46]). A model using POAF and a CHA2DS2VASc score ≥2 alone yielded a C statistic of 0.77, with appropriate calibration for the prediction of thromboembolic events. However, POAF was not an independent predictor of long-term mortality.
Conclusions:
POAF following LT is associated with an 8-fold increased risk of thromboembolic events and the use of the CHA2DS2VASc score may facilitate risk stratification of these patients. Prospective studies are warranted to assess whether the use of oral anticoagulants can reduce the risk of thromboembolism following LT.
