Chang Shantel, Lombardo Alexander, Smith Ian, Lawler Samuel, He Cheng, Stroebel Andrie
Princess Alexandra Hospital, Brisbane, Queensland, Australia.
School of Medicine and Dentistry, Griffith University, Gold Coast, Queensland, Australia.
ANZ J Surg. 2025 Jun;95(6):1135-1141. doi: 10.1111/ans.70045. Epub 2025 Feb 23.
The introduction of non-vitamin-K-antagonist oral anticoagulants (NOAC) has shifted the landscape of anticoagulation in the setting of atrial fibrillation (AF), as an alternative to warfarin. Despite extensive evidence for NOACs in non-perioperative and non-valvular AF, there remains little consensus on anticoagulation choice for patients with postoperative atrial fibrillation (POAF) after cardiac surgery.
This retrospective, observational study included 2263 patients who underwent cardiac surgery between 1 March 2016 and 13 January 2023 at a tertiary cardiac centre. Patients with pre-existing AF, valvular AF and transcatheter interventions were excluded. Short- and long-term outcomes were compared between patients who received a NOAC and those who received warfarin for POAF. A Cox regression model was constructed to identify independent predictors for time-to-mortality. Subgroup analysis was performed based on the type of surgery, including CABG-only, aortic valve replacement (AVR)-only, and combined surgery cohorts.
Of the 2263 patients, 556 (24.5%) developed POAF. Of those who developed POAF, 162 were anticoagulated with warfarin and 65 were anticoagulated with a NOAC, including apixaban, rivaroxaban and dabigatran. There were three cases of permanent stroke in the warfarin group compared with no cases in the NOAC group. All-cause 30-day and one-year readmission rates were similar between groups. The use of NOAC or warfarin did not impact overall survival in the Kaplan-Meier analysis. Subgroup analysis demonstrated similar outcomes in CABG-only, AVR-only and combined surgery groups.
Warfarin and NOAC performed similarly in short- and long-term complications, suggesting NOAC as a plausible alternative to warfarin for anticoagulation in POAF.
非维生素K拮抗剂口服抗凝药（NOAC）的引入改变了心房颤动（AF）抗凝治疗的格局，成为华法林的替代药物。尽管有大量证据表明NOAC可用于非围手术期和非瓣膜性AF，但对于心脏手术后发生术后心房颤动（POAF）的患者，抗凝治疗的选择仍未达成共识。
这项回顾性观察性研究纳入了2016年3月1日至2023年1月13日在一家三级心脏中心接受心脏手术的2263例患者。排除既往有AF、瓣膜性AF和经导管干预的患者。比较接受NOAC和接受华法林治疗POAF的患者的短期和长期结局。构建Cox回归模型以确定死亡时间的独立预测因素。根据手术类型进行亚组分析，包括单纯冠状动脉旁路移植术（CABG）、单纯主动脉瓣置换术（AVR）和联合手术队列。
在2263例患者中，556例（24.5%）发生了POAF。在发生POAF的患者中，162例接受华法林抗凝，65例接受NOAC抗凝，包括阿哌沙班、利伐沙班和达比加群。华法林组有3例永久性卒中，而NOAC组无病例。两组的全因30天和1年再入院率相似。在Kaplan-Meier分析中，使用NOAC或华法林对总体生存率没有影响。亚组分析显示，单纯CABG、单纯AVR和联合手术组的结局相似。
华法林和NOAC在短期和长期并发症方面表现相似，这表明NOAC是POAF抗凝治疗中华法林的合理替代药物。
