Cargando…

Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database

BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and is associated with increased long-term stroke and mortality. Anticoagulation has been suggested as a potential therapy, but data on safety and efficacy are scant. OBJECTIVES: To d...

Descripción completa

Detalles Bibliográficos
Autores principales: Riad, Fady S., Grau-Sepulveda, Maria, Jawitz, Oliver K., Vekstein, Andrew M., Sundaram, Varun, Sahadevan, Jayakumar, Habib, Robert H., Jacobs, Jeffrey P., O’Brien, Sean, Thourani, Vinod H., Vemulapalli, Sreekanth, Xian, Ying, Waldo, Albert L., Sabik, Joseph
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463707/
https://www.ncbi.nlm.nih.gov/pubmed/36097451
http://dx.doi.org/10.1016/j.hroo.2022.06.003
_version_ 1784787445705867264
author Riad, Fady S.
Grau-Sepulveda, Maria
Jawitz, Oliver K.
Vekstein, Andrew M.
Sundaram, Varun
Sahadevan, Jayakumar
Habib, Robert H.
Jacobs, Jeffrey P.
O’Brien, Sean
Thourani, Vinod H.
Vemulapalli, Sreekanth
Xian, Ying
Waldo, Albert L.
Sabik, Joseph
author_facet Riad, Fady S.
Grau-Sepulveda, Maria
Jawitz, Oliver K.
Vekstein, Andrew M.
Sundaram, Varun
Sahadevan, Jayakumar
Habib, Robert H.
Jacobs, Jeffrey P.
O’Brien, Sean
Thourani, Vinod H.
Vemulapalli, Sreekanth
Xian, Ying
Waldo, Albert L.
Sabik, Joseph
author_sort Riad, Fady S.
collection PubMed
description BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and is associated with increased long-term stroke and mortality. Anticoagulation has been suggested as a potential therapy, but data on safety and efficacy are scant. OBJECTIVES: To determine the association between anticoagulation for POAF and long-term outcomes. METHODS: Adult patients with POAF after isolated coronary artery bypass surgery (CABG) were identified through the Society of Thoracic Surgeons Adult Cardiac Surgery Database and linked to the Medicare Database. Propensity-matched analyses were performed for all-cause mortality, stroke, myocardial infarction, and major bleeding for patients discharged with or without anticoagulation. Interaction between anticoagulation and CHA(2)DS(2)-VASc score was also assessed. RESULTS: Of 38,936 patients, 9861 (25%) were discharged on oral anticoagulation. After propensity score matching, discharge anticoagulation was associated with increased mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.06–1.26). There was no difference in ischemic stroke between groups (HR 0.97, 95% CI 0.82–1.15), but there was significantly higher bleeding (HR 1.60, 95% CI 1.38–1.85) among those discharged on anticoagulation. Myocardial infarction was lower in the first 30 days for those discharged on anticoagulation, but this effect decreased over time. The incidence of all complications was higher for patients with CHA(2)DS(2)-VASc scores ≥5 compared to patients with scores of 2–4. Anticoagulation did not appear to benefit either subgroup. CONCLUSION: Anticoagulation is associated with increased mortality after new-onset POAF following CABG. There was no reduction in ischemic stroke among those discharged on anticoagulation regardless of CHA(2)DS(2)-VASc score.
format Online
Article
Text
id pubmed-9463707
institution National Center for Biotechnology Information
language English
publishDate 2022
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-94637072022-09-11 Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database Riad, Fady S. Grau-Sepulveda, Maria Jawitz, Oliver K. Vekstein, Andrew M. Sundaram, Varun Sahadevan, Jayakumar Habib, Robert H. Jacobs, Jeffrey P. O’Brien, Sean Thourani, Vinod H. Vemulapalli, Sreekanth Xian, Ying Waldo, Albert L. Sabik, Joseph Heart Rhythm O2 Clinical BACKGROUND: New-onset postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery and is associated with increased long-term stroke and mortality. Anticoagulation has been suggested as a potential therapy, but data on safety and efficacy are scant. OBJECTIVES: To determine the association between anticoagulation for POAF and long-term outcomes. METHODS: Adult patients with POAF after isolated coronary artery bypass surgery (CABG) were identified through the Society of Thoracic Surgeons Adult Cardiac Surgery Database and linked to the Medicare Database. Propensity-matched analyses were performed for all-cause mortality, stroke, myocardial infarction, and major bleeding for patients discharged with or without anticoagulation. Interaction between anticoagulation and CHA(2)DS(2)-VASc score was also assessed. RESULTS: Of 38,936 patients, 9861 (25%) were discharged on oral anticoagulation. After propensity score matching, discharge anticoagulation was associated with increased mortality (hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.06–1.26). There was no difference in ischemic stroke between groups (HR 0.97, 95% CI 0.82–1.15), but there was significantly higher bleeding (HR 1.60, 95% CI 1.38–1.85) among those discharged on anticoagulation. Myocardial infarction was lower in the first 30 days for those discharged on anticoagulation, but this effect decreased over time. The incidence of all complications was higher for patients with CHA(2)DS(2)-VASc scores ≥5 compared to patients with scores of 2–4. Anticoagulation did not appear to benefit either subgroup. CONCLUSION: Anticoagulation is associated with increased mortality after new-onset POAF following CABG. There was no reduction in ischemic stroke among those discharged on anticoagulation regardless of CHA(2)DS(2)-VASc score. Elsevier 2022-06-16 /pmc/articles/PMC9463707/ /pubmed/36097451 http://dx.doi.org/10.1016/j.hroo.2022.06.003 Text en © 2022 Heart Rhythm Society. Published by Elsevier Inc. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Clinical
Riad, Fady S.
Grau-Sepulveda, Maria
Jawitz, Oliver K.
Vekstein, Andrew M.
Sundaram, Varun
Sahadevan, Jayakumar
Habib, Robert H.
Jacobs, Jeffrey P.
O’Brien, Sean
Thourani, Vinod H.
Vemulapalli, Sreekanth
Xian, Ying
Waldo, Albert L.
Sabik, Joseph
Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title_full Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title_fullStr Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title_full_unstemmed Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title_short Anticoagulation in new-onset postoperative atrial fibrillation: An analysis from the Society of Thoracic Surgeons Adult Cardiac Surgery Database
title_sort anticoagulation in new-onset postoperative atrial fibrillation: an analysis from the society of thoracic surgeons adult cardiac surgery database
topic Clinical
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9463707/
https://www.ncbi.nlm.nih.gov/pubmed/36097451
http://dx.doi.org/10.1016/j.hroo.2022.06.003
work_keys_str_mv AT riadfadys anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT grausepulvedamaria anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT jawitzoliverk anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT veksteinandrewm anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT sundaramvarun anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT sahadevanjayakumar anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT habibroberth anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT jacobsjeffreyp anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT obriensean anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT thouranivinodh anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT vemulapallisreekanth anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT xianying anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT waldoalbertl anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase
AT sabikjoseph anticoagulationinnewonsetpostoperativeatrialfibrillationananalysisfromthesocietyofthoracicsurgeonsadultcardiacsurgerydatabase