Systemic Anticoagulation at Discharge in Cardiac Surgical Patients With Postoperative Atrial Fibrillation: A Statewide Cohort Study

Abstract

Background

Direct oral anticoagulants (DOACs) have changed systemic anticoagulation practice for atrial fibrillation. We hypothesized that DOACs are increasingly used for postoperative atrial fibrillation after cardiac surgery, and associated with fewer anticoagulation-related complications compared with warfarin.

Methods

We performed a retrospective cohort study of patients undergoing coronary artery bypass grafting, valve surgery, or combined coronary artery bypass grafting/valve surgery from 2011 through 2023 using a statewide database. The primary outcome was systemic anticoagulation at discharge in patients with postoperative atrial fibrillation. Secondary outcomes were length of hospital stay, unplanned readmission for anticoagulation-related complications, and unplanned readmission for stroke or cardiac tamponade.

Results

The incidence of postoperative atrial fibrillation was 23.8% among 45,258 patients who met study inclusions, and 32.5% of patients with postoperative atrial fibrillation were discharged on systemic anticoagulation. DOAC prescription at discharge for patients with postoperative atrial fibrillation increased from 1.9% in 2011 to 32.3% in 2023. Postoperative length of stay was shorter in those who received a DOAC vs warfarin (7 vs 9 days, P < .001). There were 3 DOAC patients readmitted with anticoagulation-related complications during the study period (0.2%) compared with 20 patients taking warfarin (0.9%) (P = .01). There were no differences in readmission for stroke or cardiac tamponade (P = .29 and P = .18, respectively) between groups.

Conclusions

Systemic anticoagulation was prescribed for approximately a third of patients with postoperative atrial fibrillation after cardiac surgery. There was an increase in DOAC use over time, which appears to be associated with fewer anticoagulation-related complications.