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Published on: February 28, 2012
Early anti-coagulation therapy in new-onset atrial fibrillation after coronary artery bypass grafting: a randomized
Mojgan Ghavami1, Kaveh Hosseini2, Alireza Abdshah3,4
1Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, North Kargar Street, Tehran, 1411713138, Iran. M_ghavami@razi.tums.ac.ir.
Insights
Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) increases stroke risk. This study found Warfarin and Rivaroxaban equally safe and effective in preventing thrombotic events in POAF patients, suggesting DOACs may be preferred.
Area of Science:
- Cardiology
- Vascular Surgery
- Pharmacology
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication following coronary artery bypass grafting (CABG).
- POAF elevates the risk of embolic and stroke events.
- Evidence regarding anticoagulant use, specifically comparing Warfarin and Direct Oral Anticoagulants (DOACs), in POAF patients post-CABG is limited.
Purpose of the Study:
- To assess the feasibility and safety of Warfarin versus Rivaroxaban for preventing thrombotic events in patients with POAF after isolated CABG.
- To compare major and minor bleeding events and thrombotic episodes between the two anticoagulant groups.
Main Methods:
- A randomized controlled trial involving 66 patients undergoing isolated CABG.
- Patients were allocated 1:1 to receive either Rivaroxaban (34 patients) or Warfarin (32 patients).
- Primary outcome was major bleeding within 30 days post-discharge; secondary outcomes included minor bleeding and thrombotic events.
Main Results:
- No thrombotic episodes were reported in either the Rivaroxaban or Warfarin group.
- No major bleeding events occurred in either treatment arm.
- Four minor bleeding events were observed, with no statistically significant difference between groups (P=0.6). Patients with POAF exhibited larger left atrial diameters than those in normal sinus rhythm (40.5 vs. 37.8 mm, P=0.01).
Conclusions:
- Both Warfarin and Rivaroxaban demonstrated safety and efficacy in preventing thrombotic events in POAF patients post-CABG.
- No significant difference in major bleeding was noted between the two anticoagulants.
- Findings suggest DOACs like Rivaroxaban may be preferable due to convenience and ease of management.
Background:
New-onset postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) surgery, increasing the risk of embolism and stroke. There is a lack of information on the use of anticoagulants in this context. The choice between Warfarin and Direct oral anticoagulants (DOACs) also is not well-established. This randomized study aimed to compare the feasibility and safety of Warfarin and Rivaroxaban in preventing thrombotic events in POAF patients after isolated CABG.
Methods:
A total of 66 patients were randomized parallelly with 1:1 allocation to receive either Rivaroxaban (n = 34) or Warfarin (n = 32). Major bleeding events within 30 days after discharge were the primary outcome. Secondary outcomes included minor bleeding events and thrombotic episodes. Clinical characteristics, medication regimens, and left atrial diameter were assessed. Statistical analyses were performed using appropriate tests.
Results:
No thrombotic episodes were observed in either treatment arm. No major bleeding events occurred in either group. Four minor bleeding events were reported, with no significant difference between the treatment groups (P = 0.6). Patients with atrial fibrillation had significantly larger left atrial diameters compared to those with normal sinus rhythm (40.5 vs. 37.8 mm, P = 0.01).
Conclusions:
This pilot study suggests that Warfarin and Rivaroxaban are both safe and effective for preventing thrombotic episodes in POAF patients after isolated CABG. No significant differences in major bleeding events were observed between the two anticoagulants. These findings may support the preference for DOACs like Rivaroxaban due to their convenience and easier maintenance.
Trial Registration:
Number IRCT20200304046696N1, Date 18/03/2020 https//irct.behdasht.gov.ir/ .
