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The following is a summary of ‘Anticoagulation for postoperative AF after isolated CABG,” published in the May 2024 issue of Cardiology by Kar et al.

Postoperative atrial fibrillation (POAF) is one of the most common complications after coronary artery bypass grafting (CABG) surgery. 

Researchers conducted a retrospective study to understand the impact of oral anticoagulation (OAC) in patients developing POAF after CABG.

They searched for studies on post-CABG POAF and OAC use, analyzing the risks of thromboembolic events, bleeding, and mortality. A meta-analysis was conducted on the outcomes stratified by use or non-use of OAC. Using a fixed-effects model for results interpretation and a random-effects model, pooled outcomes with hazard ratios and 95% CI were reported. 

The results showed that in 1,698,307 patients with CABG, POAF rates ranged from 7.9% to 37.6%, and from all patients with POAF, 15.5% received OAC. Within 30 days, patients with POAF had lower thromboembolic rates (1.0%, [POAF: 0.3%, non-POAF: 0.8%]) and higher mortality (2.0%, [POAF: 1.0%, non-POAF 0.5%]). Bleeding rates in both groups differed significantly (POAF: 1.1%, non-POAF 2.7%). Over a median follow-up of 4.6 years, the POAF group had 1.73 thromboembolic events, 3.39 mortality, and 2.00 bleeding events per 100 person-years, whereas patients without POAF had 1.14, 2.19, and 1.60, respectively. Patients receiving OAC had similar thromboembolic risks and mortality but higher bleeding rates compared to nonusers. The difference between thromboembolic risks (effect size -0.11 [-0.36 to 0.13]) and mortality (effect size -0.07 (-0.21 to 0.07)) was observed between users and non-users of OAC. Patients receiving OAC also had a higher bleeding rate compared to nonusers.  

Investigators concluded that complications in patients with POAF after CABG were rare, but using OAC in the patients increased bleeding risk.

Source: acc.org/Latest-in-Cardiology/Journal-Scans/2024/05/31/14/52/anticoagulation-for-postoperative