A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?

A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?

Author Info

Corresponding Author
Nitin Tandan
Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA

A B S T R A C T

Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on whether these patients would benefit from chronic anticoagulation. Objective: To assess whether patients with POAF benefit from chronic anticoagulation. Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of ischemic stroke, and mortality. Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant differences found in mortality outcomes between POAF patients that received anticoagulation as compared to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857, P = 0.5447). Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further prospective studies into the question of length of POAF and how chronic anticoagulation therapy plays a role in decreasing risks of ischemic stroke and/or mortality.

Article Info

Article Type
Research Article
Publication history
Received: Wed 15, Apr 2020
Accepted: Wed 15, Apr 2020
Published: Wed 15, Apr 2020
Copyright
© 2023 Nitin Tandan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.JICOA.2020.02.02