A Doctor’s Dilemma: Postoperative Atrial Fibrillation – Should We Anticoagulate?

Background: Postoperative atrial fibrillation (POAF) is a relatively common phenomenon, occurring in approximately 20-40% of cases. Previous studies and guidelines from the AHA/ACC recommended initiating anticoagulation in patients with POAF lasting over 48 hours. However, a few recent studies suggest improved outcomes after anticoagulation even at 5 minutes of POAF. Our meta-analysis aims to clarify primary outcomes of ischemic stroke and mortality in patients with POAF and to offer guidance on whether these patients would benefit from chronic anticoagulation. Objective: To assess whether patients with POAF benefit from chronic anticoagulation. Methods: Through PubMed, OVID, and MEDLINE, we performed a literature review of several studies to assess whether patients with short-lived atrial fibrillation benefit from anticoagulation. Although several studies provided valuable information, we selected 6 studies that reported the duration of POAF, risks of ischemic stroke, and mortality. Results: We found that patients that received anticoagulation due to newly diagnosed POAF were 3.5-times less likely to experience an ischemic stroke than patients who did not receive anticoagulation with newly diagnosed POAF (IRR 3.54 (95% CI 2.12-5.91), p=0.001.). There were no statistically significant differences found in mortality outcomes between POAF patients that received anticoagulation as compared to those patients that did not receive anticoagulation (Pooled IRR = 1.1449 (95% CI = 0.738952 to 1.773857, P = 0.5447). Conclusion: Patients with POAF over 24 hours duration were less likely to experience ischemic stroke if they were placed on anticoagulation.We hope that this meta-analysis would promote further prospective studies into the question of length of POAF and how chronic anticoagulation therapy plays a role in decreasing risks of ischemic stroke and/or mortality.