View in EDS

Early use of non‐vitamin K antagonist oral anticoagulants after cardiac surgery compared with warfarin for postoperative atrial fibrillation

Saved in:
Bibliographic Details
Title: Early use of non‐vitamin K antagonist oral anticoagulants after cardiac surgery compared with warfarin for postoperative atrial fibrillation
Authors: Shantel Chang, Alexander Lombardo, Ian Smith, Samuel Lawler, Cheng He, Andrie Stroebel
Source: ANZ J Surg
Publisher Information: Wiley, 2025.
Publication Year: 2025
Subject Terms: Cardiothoracic Surgery
Description: BackgroundThe introduction of non‐vitamin‐K‐antagonist oral anticoagulants (NOAC) has shifted the landscape of anticoagulation in the setting of atrial fibrillation (AF), as an alternative to warfarin. Despite extensive evidence for NOACs in non‐perioperative and non‐valvular AF, there remains little consensus on anticoagulation choice for patients with postoperative atrial fibrillation (POAF) after cardiac surgery.MethodsThis retrospective, observational study included 2263 patients who underwent cardiac surgery between 1 March 2016 and 13 January 2023 at a tertiary cardiac centre. Patients with pre‐existing AF, valvular AF and transcatheter interventions were excluded. Short‐ and long‐term outcomes were compared between patients who received a NOAC and those who received warfarin for POAF. A Cox regression model was constructed to identify independent predictors for time‐to‐mortality. Subgroup analysis was performed based on the type of surgery, including CABG‐only, aortic valve replacement (AVR)‐only, and combined surgery cohorts.ResultsOf the 2263 patients, 556 (24.5%) developed POAF. Of those who developed POAF, 162 were anticoagulated with warfarin and 65 were anticoagulated with a NOAC, including apixaban, rivaroxaban and dabigatran. There were three cases of permanent stroke in the warfarin group compared with no cases in the NOAC group. All‐cause 30‐day and one‐year readmission rates were similar between groups. The use of NOAC or warfarin did not impact overall survival in the Kaplan–Meier analysis. Subgroup analysis demonstrated similar outcomes in CABG‐only, AVR‐only and combined surgery groups.ConclusionsWarfarin and NOAC performed similarly in short‐ and long‐term complications, suggesting NOAC as a plausible alternative to warfarin for anticoagulation in POAF.
Document Type: Article
Other literature type
Language: English
ISSN: 1445-2197
1445-1433
DOI: 10.1111/ans.70045
Access URL: https://pubmed.ncbi.nlm.nih.gov/39988902
Rights: CC BY NC
Accession Number: edsair.doi.dedup.....16fec67c86fb77f8d47034cccce4aaae
Database: OpenAIRE
Description
Abstract:BackgroundThe introduction of non‐vitamin‐K‐antagonist oral anticoagulants (NOAC) has shifted the landscape of anticoagulation in the setting of atrial fibrillation (AF), as an alternative to warfarin. Despite extensive evidence for NOACs in non‐perioperative and non‐valvular AF, there remains little consensus on anticoagulation choice for patients with postoperative atrial fibrillation (POAF) after cardiac surgery.MethodsThis retrospective, observational study included 2263 patients who underwent cardiac surgery between 1 March 2016 and 13 January 2023 at a tertiary cardiac centre. Patients with pre‐existing AF, valvular AF and transcatheter interventions were excluded. Short‐ and long‐term outcomes were compared between patients who received a NOAC and those who received warfarin for POAF. A Cox regression model was constructed to identify independent predictors for time‐to‐mortality. Subgroup analysis was performed based on the type of surgery, including CABG‐only, aortic valve replacement (AVR)‐only, and combined surgery cohorts.ResultsOf the 2263 patients, 556 (24.5%) developed POAF. Of those who developed POAF, 162 were anticoagulated with warfarin and 65 were anticoagulated with a NOAC, including apixaban, rivaroxaban and dabigatran. There were three cases of permanent stroke in the warfarin group compared with no cases in the NOAC group. All‐cause 30‐day and one‐year readmission rates were similar between groups. The use of NOAC or warfarin did not impact overall survival in the Kaplan–Meier analysis. Subgroup analysis demonstrated similar outcomes in CABG‐only, AVR‐only and combined surgery groups.ConclusionsWarfarin and NOAC performed similarly in short‐ and long‐term complications, suggesting NOAC as a plausible alternative to warfarin for anticoagulation in POAF.
ISSN:14452197
14451433
DOI:10.1111/ans.70045