Oral anticoagulation after POAF post-CABG reduced thromboembolic mortality from 0.42 to 0.04 and cardiovascular mortality from 1.39 to 0.22 per 100 person-years within 30 days.
Does oral anticoagulation reduce cardiovascular and thromboembolic mortality compared to antiplatelet therapy in patients with new-onset postoperative atrial fibrillation after CABG?
In patients with postoperative atrial fibrillation after CABG, oral anticoagulation significantly reduces cardiovascular and thromboembolic mortality within the first 30 days, but offers no additional long-term survival benefit.
Absolute Event Rate: 0% vs 0%
Abstract Background New-onset postoperative atrial fibrillation (POAF) affects 15–40% of patients following coronary artery bypass grafting (CABG). Risk stratification tools are poorly suited to this condition due to its transient nature, and the evidence for long-term oral anticoagulation (OAC) is limited. Guidelines recommend OAC based on thromboembolic risk after bleeding risk resolves, but unclear guidance and limited real-world data contribute to practice variation. Addressing these gaps is vital to improve outcomes and reduce healthcare burden. Methods This retrospective cohort study analysed the management of POAF in patients aged ≥18 years undergoing isolated CABG (2013–2022) using data from coupled Dutch registries. Patients with prior AF, OAC use, or concomitant valve surgery were excluded from the study. The outcomes included short-term complications and cardiovascular mortality, stratified by thromboembolic and bleeding-related causes, comparing OAC with antiplatelet therapy. Results In the Netherlands, between 2013 and 2022, 44,601 isolated CABG patients were identified, of whom 24.8% developed POAF. Of these patients (mean age 68.9, 81.7% male), 43.6% received OAC, with a gradual increase from 38.7% in 2013 to 53.7% in 2022. However, long-term adherence to OAC declined, with only 10.3% of patients still using OAC after a decade. Short-term complications were rare, with CVAs in 1.3% of cases and bleeding requiring reintervention in 5.4%. Thromboembolic mortality was found to be significantly lower in patients who received OACs (0.04 vs. 0.42 per 100 person-years; RR 0.10, p0.001), as was cardiovascular mortality (0.22 vs. 1.39; RR 0.16, p0.001). Early cardiovascular survival was significantly better in OAC users within the first 30 days postoperatively (p0.0001). A similar outcome was observed in the analysis of thromboembolic survival at one year, which exhibited a marked difference (p0.0001), primarily attributable to events occurring within the first 30 days. However, no significant additional survival difference developed between groups from 30 days to 1 year (p=0.49 and p=0.24, respectively). The incidence of bleeding-related mortality remained low and comparable in both groups. Conclusions In this large real-life cohort of patients with POAF after CABG, the administration of OACs was associated with a significant reduction in cardiovascular and thromboembolic mortality within 30 days; however, no improvement in long-term survival was observed. The declining use of OAC over time did not lead to an increase in thromboembolic mortality, indicating that early postoperative anticoagulation may be the most effective strategy for risk mitigation. These findings underscore the need for better risk stratification tools for transient POAF and highlight the importance of evaluating early postoperative mortality causes to further refine OAC strategies.Survival curve Cardiovascular mortality Survival curve Thromboembolic mortality
Kar et al. (Sat,) reported a other. Oral anticoagulation after POAF post-CABG reduced thromboembolic mortality from 0.42 to 0.04 and cardiovascular mortality from 1.39 to 0.22 per 100 person-years within 30 days.