Desenlaces en pacientes que desarrollan fibrilación auricular durante el postoperatorio cardiovascular en la Fundación Cardioinfantil. 2017 - 2020

Abstract

Introduction Atrial fibrillation is the most frequent arrhythmia in the population. Present between 20 and 40% during cardiovascular POP. Its treatment includes oral anticoagulants to prevent systemic embolism, however, it is related to complications such as bleeding and thrombosis, both in the immediate postoperative period and in the long term. In recent years, anticoagulants have emerged with equal or greater efficacy and safety than warfarin. There is no strong evidence for the use of these direct oral anticoagulants in POP AF. Therefore, it is necessary to evaluate the results of these anticoagulants, in terms of bleeding and embolism, to make the best decision for these patients. • Methods We conducted a cross-sectional study, evaluating 224 patients with AF due to cardiovascular POP. We analyzed the association between complications in terms of bleeding and thrombosis with the type of anticoagulation, warfarin versus DOAC, as well as risk factors for bleeding, thrombosis, length of hospital stay and other complications. • Results In 224 patients, POP AF appeared in approximately 57 hours. It occurred despite beta-blocker in 202 patients. Rhythm control was performed in 90% of the 10% who received medication to control heart rate. Postoperative echocardiograms documented pericardial effusion in 23%. Reintervention for bleeding was performed in 26%. Embolic complications occurred in 4.9%, more frequent in the central nervous system (2.2%). An AF recurrence rate of 49% (110) was observed after discharge. We found no statistically significant differences between the anticoagulant groups for the previously described outcomes (eg, bleeding, p = 0.96), although a greater tendency to bleeding was observed with warfarin. • Discussion There is little evidence on the risks and benefits of oral anticoagulation for AF in POP. In contrast, our study found no significant differences between the outcomes of patients anticoagulated with DOACs versus warfarin. In our study, few patients (20) received DOACs, which could influence the results. Randomized controlled trials with representative samples are required to provide better evidence-based recommendations.