Anticoagulation for post-operative atrial fibrillation after isolated coronary artery bypass grafting: a meta-analysis

Mileen R. D. van de Kar*, Thomas J. van Brakel, Marcel Van't Veer, Gijs J. van Steenbergen, Edgar J. Daeter, Harry J. G. M. Crijns, Dennis van Veghel, Lukas R. C. Dekker, Luuk C. Otterspoor

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background and This study aimed to evaluate clinical outcomes in patients developing post-operative atrial fibrillation (POAF) after coronary Aims artery bypass grafting (CABG) and characterize variations in oral anticoagulation (OAC) use, benefits, and complications. Methods A systematic search identified studies on new-onset POAF after CABG and OAC initiation. Outcomes included risks of thromboembolic events, bleeding, and mortality. Furthermore, a meta-analysis was conducted on these outcomes, stratified by the use or non-use of OAC. Results The identified studies were all non-randomized. Among 1 698 307 CABG patients, POAF incidence ranged from 7.9% to 37.6%. Of all POAF patients, 15.5% received OAC. Within 30 days, thromboembolic events occurred at rates of 1.0% (POAF: 0.3%; non-POAF: 0.8%) with 2.0% mortality (POAF: 1.0%; non-POAF: 0.5%). Bleeding rates were 1.1% for POAF patients and 2.7% for non-POAF patients. Over a median of 4.6 years, POAF patients had 1.73 thromboembolic events, 3.39 mortality, and 2.00 bleeding events per 100 person-years; non-POAF patients had 1.14, 2.19, and 1.60, respectively. No significant differences in thromboembolic risks [effect size −0.11 (−0.36 to 0.13)] and mortality [effect size −0.07 (−0.21 to 0.07)] were observed between OAC users and non-users. However, OAC use was associated with higher bleeding risk [effect size 0.32 (0.06-0.58)]. Conclusions In multiple timeframes following CABG, the incidence of complications in patients who develop POAF is low. The use of OAC in patients with POAF after CABG is associated with increased bleeding risk.

Original languageEnglish
Pages (from-to)2620-2630
Number of pages11
JournalEuropean Heart Journal
Volume45
Issue number29
Early online date1 May 2024
DOIs
Publication statusPublished - 1 Aug 2024

Keywords

  • Post-operative atrial fibrillation
  • Coronary artery bypass grafting
  • Antiplatelet therapy
  • Anticoagulation
  • LONG-TERM RISK
  • CARDIAC-SURGERY
  • ORAL ANTICOAGULANTS
  • STROKE PREVENTION
  • APPENDAGE CLOSURE
  • BLOOD-PRESSURE
  • MORTALITY
  • MANAGEMENT
  • OUTCOMES
  • COMMUNITY

Fingerprint

Dive into the research topics of 'Anticoagulation for post-operative atrial fibrillation after isolated coronary artery bypass grafting: a meta-analysis'. Together they form a unique fingerprint.

Cite this