Anticoagulant Prescribing Patterns in New-Onset Atrial Fibrillation After Cardiac Surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Pharmacology

Background:

• Postoperative atrial fibrillation (POAF) is a frequent complication following cardiac surgery.
• POAF increases the risk of thromboembolic stroke.
• Optimal anticoagulant strategies for POAF remain unclear.

Purpose of the Study:

• To investigate the utilization and outcomes of oral anticoagulants (OACs) in patients with POAF after cardiac surgery.
• To evaluate the association between OAC use and the risk of stroke, systemic embolism, and bleeding.

Main Methods:

• Retrospective analysis of administrative databases from January 2015 to December 2020.
• Inclusion of adult patients with new-onset POAF post-cardiac surgery.
• Exclusion of patients with pre-existing atrial fibrillation, mechanical valves, or recent anticoagulant use.

Main Results:

• 27.3% of patients with POAF were discharged on an OAC, primarily warfarin.
• Over half of patients discontinued OACs within 6 months.
• No significant difference in stroke or systemic embolism rates was observed between OAC users and non-users at 30 days, 3 months, or 6 months.
• OAC use was associated with higher rates of bleeding at all time points.

Conclusions:

• A small proportion of patients with POAF receive OACs post-cardiac surgery.
• OAC initiation in this cohort was linked to an increased bleeding risk without a clear reduction in stroke events.
• Careful risk-benefit assessment is crucial when considering anticoagulation for POAF, especially regarding bleeding risk in the postoperative period.