OAC use in post-operative AF patients increased from 54.9% at EBCR admission to 71.1% at discharge, with a slight preference for VKAs over NOACs.
What proportion of patients with post-operative atrial fibrillation receive oral anticoagulation, and how do treatment strategies evolve during exercise-based cardiac rehabilitation?
Despite Class IIa guideline recommendations, nearly half of patients with post-operative atrial fibrillation are not prescribed oral anticoagulation upon admission to cardiac rehabilitation, though prescription rates improve to approximately 70% by discharge.
Absolute Event Rate: 0% vs 0%
Abstract Background/Introduction Post-operative atrial fibrillation (AF), defined as the new onset of AF during or shortly after cardiac surgery is highly prevalent with an incidence of 30–50%. However, evidence supporting oral anticoagulation (OAC) in these patients to prevent stroke remains limited as reflected by its Class IIa recommendation in current guidelines. The risk of stroke without OAC must be weighed against the potential for significant bleeding with OAC, leading to highly individualized treatment approaches. Purpose This study aimed to assess the proportion of patients receiving OAC after post-operative (POAF) and to evaluate how treatment strategies evolved during exercise-based cardiac rehabilitation (EBCR). Methods This retrospective single-center cohort study examined cardiac surgery patients who were admitted to inpatient EBCR between 2022 and 2024. The diagnosis of POAF included both paroxysmal and persistent AF. Patients with a pre-surgery existing AF diagnosis were excluded from the analysis. Anticoagulation was defined as the use of either a non-vitamin K antagonist oral anticoagulant (NOAC) or a vitamin K antagonist (VKA). The two assessment time points correspond to admission and the individual discharge day from EBCR. Results A total of 142 patients were included in this study. The median length of stay in EBCR was 22 days (quartiles 20–27). 26% were women with a median age of 66 years (quartiles 59–72) and a median left ventricular ejection fraction (LVEF) of 51.5% (quartiles 45.0–57.0). At admission, 78 of these patients (54.9%) were on OAC. Of them, 28 (35.9%) received NOACs and 50 (64.1%) VKAs. At discharge, the distribution of OAC therapy shifted to 101 patients (71.1%), where 44 patients (43.6%) received NOACs and 57 (56.4%) VKAs. Conclusion In our study, almost half of the patients with postoperative AF were not prescribed an OAC on admission, despite a Class IIa recommendation. At the end of EBCR approximately 70% had been initiated to OAC with a slight preference for VKAs. Future research should assess long-term outcomes in well-controlled longitudinal studies to investigate the actual safety and clinical relevance of OAC in this patient population.Distribution of anticoagulation therapy
Riess et al. (Sat,) reported a other. OAC use in post-operative AF patients increased from 54.9% at EBCR admission to 71.1% at discharge, with a slight preference for VKAs over NOACs.