Related Experiment Video
Updated: Aug 2, 2025

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Anticoagulation use in perioperative atrial fibrillation after noncardiac surgery: a systematic review and
Michael Ke Wang1,2,3, Rachel Heo4, Pascal B Meyre5
1Department of Medicine, McMaster University, Hamilton (ON), Canada.
Insights
Anticoagulation therapy for perioperative atrial fibrillation may reduce stroke and death risk but increases bleeding. More research, including randomized trials, is needed to confirm these findings for patients undergoing noncardiac surgery.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Perioperative atrial fibrillation (AF) increases risks of stroke, myocardial infarction, and death after noncardiac surgery.
- Anticoagulation is standard for non-surgical AF stroke prevention, but its role in perioperative AF is unclear.
Conclusions:
- Anticoagulation shows potential benefits in reducing stroke and death but carries an increased bleeding risk in perioperative AF.
- The current evidence quality is very low, necessitating randomized controlled trials.
- Further research is crucial to establish definitive anticoagulation guidelines for perioperative AF.
Background:
Perioperative atrial fibrillation is associated with an increased risk of stroke, myocardial infarction, and death after noncardiac surgery. Anticoagulation therapy is effective for stroke prevention in nonsurgical atrial fibrillation, but its efficacy and safety in perioperative atrial fibrillation are unknown.
Methods:
We searched MEDLINE, EMBASE, and CENTRAL from database inception until January 2022. We included studies comparing anticoagulation versus no anticoagulation use in patients with perioperative atrial fibrillation after noncardiac surgery. Our study outcomes included stroke ± systemic embolism, bleeding, mortality, myocardial infarction, and venous thromboembolism. We pooled studies using fixed-effects models. We reported summary risk ratios (RRs) for studies reporting multivariable-adjusted results.
Results:
Seven observational studies but no randomised trials were included. Of the 27,822 patients, 29.1% were prescribed therapeutic anticoagulation. Anticoagulation use was associated with a lower risk of stroke ± systemic embolism (RR 0.73; 95% CI, 0.62-0.85; I2 = 81%; 3 studies) but a higher risk of bleeding (RR 1.14; 95% CI, 1.04-1.25; 1 study). There was a lower risk of mortality associated with anticoagulation use (RR 0.45; 95% CI, 0.40-0.51; I2 = 80%; 2 studies). There was no difference in the risk of myocardial infarction (RR 2.19; 95% CI, 0.97-4.96; 1 study). The certainty of the evidence was very low across all outcomes.
Conclusion:
Anticoagulation is associated with a reduced risk of stroke and death but an increased risk of bleeding. The quality of the evidence is very poor. Randomised trials are needed to better determine the effects of anticoagulation use in this population.
Related Concept Videos
Aneurysm IV: Nursing Management
Venous Thrombosis III: Interprofessional Care
Anticoagulant Drugs: Low-Molecular-Weight Heparins
Anticoagulant Drugs: Vitamin K Antagonists and Direct Oral Anticoagulants
Warfarin, a prominent vitamin K antagonist family member, exerts its effect by inhibiting the enzyme VKORC1 (vitamin K epoxide reductase complex 1). By hindering this enzyme, warfarin...
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Peripheral Artery Disease V: Postoperative Nursing Management

