Anticoagulation management of post-cardiac surgery new-onset atrial fibrillation

Abstract

New-onset post-cardiac surgery atrial fibrillation (PCSAF) is a frequent complication with estimated incidence of 17% to 64%, depending on type of surgery. It is associated with higher mortality, morbidity, and predisposition to stroke and systemic embolism postoperatively. Standard care involves rate or rhythm control, in addition to antithrombotic therapy in those with history of stroke, transient ischemic attack, or high risk of systemic thromboembolism. However, risk of bleeding is not negligible, and treating physicians should weigh the risks and benefits before committing to postoperative anticoagulation therapy. More investigations are warranted to explore antithrombotic therapy benefit, particularly postoperative anticoagula-tion, considering the potentially self-limited nature of the arrhythmia and high risk of postoperative bleeding. KEY POINTS Anticoagulation should be weighed against potential risk of postoperative bleeding for patients with new-onset PCSAF as it is potentially transient and self-limited.