Breaking News
July 23, 2018 - Yeast species used in biotechnology, food industries causes drug-resistant yeast infections
July 23, 2018 - Breath analyses may help detect pancreatic cancer earlier, study shows
July 23, 2018 - Study reports data on dementia prevalence in sexual minority older adults
July 23, 2018 - Children of mothers with type 1 diabetes at greater risk of being overweight
July 23, 2018 - Deep brain stimulation found to improve diabetes symptoms
July 23, 2018 - New breeding technologies could enhance shape, size, color, and health benefits of produce
July 23, 2018 - Pfizer announces FDA approval of biosimilar to Neupogen
July 23, 2018 - Key questions to consider for sustainable management of environmental risks in Europe
July 23, 2018 - Vaxart Announces Publication of the Phase 1 Results of its Oral Norovirus Tablet Vaccine in Journal of Clinical Investigation Insight
July 23, 2018 - Joslin researchers report excessive fetal growth despite well-controlled type 1 diabetes
July 23, 2018 - Former inmates more likely to die of opioid overdose after prison release
July 23, 2018 - New study offers robust insights into under-treatment of women with heart attacks
July 23, 2018 - Doctors’ ‘gut feelings’ play key role in medical decision making, finds study
July 23, 2018 - Tooth enamel that regrows? Researcher says revolutionary gel could make it possible
July 23, 2018 - ECU researchers develop world’s first blood test that detects melanoma in its early stages
July 23, 2018 - Researchers explore future of houseplants as functional sirens of home health
July 23, 2018 - No Outcome Differences Based on Anesthesia Team Make-Up
July 23, 2018 - Getting to the heart of congenital cardiac defects
July 23, 2018 - Healthy behaviors are not effective in preventing gestational diabetes in obese women
July 23, 2018 - Top of Teachers’ To-Do List: Focus on the Positives
July 23, 2018 - LDL quality is a novel, modifiable cardiovascular risk marker
July 22, 2018 - Researchers identify enzyme as potential new drug target for blood disorders
July 22, 2018 - Research shows that neurons can encode more than one signal at a time
July 22, 2018 - Exposure to secondhand smoke increases the risk of stillbirth
July 22, 2018 - Skin conditions by the numbers
July 22, 2018 - Brain tumour chemotherapy now available to even more NHS patients
July 22, 2018 - Researchers find mugwort pollen as major source of airborne endotoxins
July 22, 2018 - Occupational safety and health at workplace
July 22, 2018 - Pfizer And Lilly Announce Positive Top-Line Results From Phase 3 Trial Of Tanezumab For The Treatment Of Osteoarthritis (OA) Pain
July 22, 2018 - Early supper associated with lower risk of breast and prostate cancer
July 22, 2018 - Survey results identify major inequalities in acute stroke treatment across Europe
July 22, 2018 - Researchers discover promising treatment for genetic form of autism spectrum disorder
July 22, 2018 - Prenatal Depression More Common in Young Moms Today
July 22, 2018 - What helps adults with autism get and keep a job?
July 22, 2018 - Pediatric NEXUS Head CT DI guides selective imaging decisions in blunt trauma patients
July 22, 2018 - Novel tool predicts genes that cause disease due to production of truncated proteins
July 22, 2018 - AHA: Vaping Tied to Blood Clots — in Mice
July 22, 2018 - Study finds therapy dogs effective in reducing symptoms of ADHD
July 22, 2018 - Scientists find reason why malarial parasites are faster than immune cells
July 22, 2018 - Researchers gain more insight into how FUS protein causes ALS and FTLD
July 22, 2018 - Frequency of joint replacements halved in rheumatoid arthritis patients between 1997-2010
July 22, 2018 - QUT researcher highlights growing impact of non-prescription antibiotics supply in pharmacies
July 22, 2018 - UK health communication researcher seeks solutions for disposing leftover medicine
July 22, 2018 - Pfizer Initiates Pivotal Phase 3 Program for Investigational Hemophilia B Gene Therapy Fidanacogene Elaparvovec
July 22, 2018 - Mutation discovered to protect against Alzheimer’s disease in mice
July 22, 2018 - Researchers reveal how patients in urban areas develop multiple, long-term conditions
July 22, 2018 - Replacing conventional cancer treatment with complementary therapy linked to increased risk of death
July 22, 2018 - Study uncovers molecular key for delaying progression of multiple sclerosis
July 22, 2018 - Availability of athletic trainer in high school reduces injury rates in girls’ sports, shows study
July 22, 2018 - FDA Approves Krintafel (tafenoquine) for the Radical Cure of Plasmodium vivax Malaria
July 22, 2018 - Novel nuclear medicine probe will help assess new drugs for neurodegenerative diseases
July 22, 2018 - Physical activity even during exposure to air pollution can reduce risk of heart attack
July 22, 2018 - Scientists discover protein regulator of myelin production
July 22, 2018 - Sleep disturbances associated with higher dementia risk
July 22, 2018 - Scientists move one step further in developing eye drops to treat age-related macular degeneration
July 22, 2018 - Five-Year Stroke Rates Lower After PCI Versus CABG
July 21, 2018 - Alopecia areata – Genetics Home Reference
July 21, 2018 - Study identifies overdose risk factors in youth with substance use disorders
July 21, 2018 - Drug in clinical trials for Parkinson’s disease offers hope for treating heart failure
July 21, 2018 - Coupling free malaria tests with diagnosis-dependent vouchers can improve rational use of ACTs
July 21, 2018 - Sweetness depends on molecular interactions between specific sugars and water in saliva
July 21, 2018 - Muscle fitness is strongly associated with improved rate of ageing in the brain
July 21, 2018 - Resetting E-Prescriptions for Opioids Helps Curb Use: Study
July 21, 2018 - Overuse of antibiotics not what the doctor ordered
July 21, 2018 - Bundled-payment system did not lower costs for serious medical conditions, shows study
July 21, 2018 - Therapy dogs found to be effective in reducing ADHD symptoms in children
July 21, 2018 - Could rotating multiple therapists better treat PTSD patients?
July 21, 2018 - Binge drinking impairs working memory in adolescent brain
July 21, 2018 - Dying at home could be beneficial for terminally ill cancer patients and their relatives
July 21, 2018 - Researchers identify subtypes of retinal ganglion cells using single-cell RNA sequencing
July 21, 2018 - Study uncovers opportunities to reduce death by suicide among cancer patients
July 21, 2018 - Genetic sequencing reveals new clues to aggressiveness of prostate cancer
July 21, 2018 - BioSight Launches a Phase 2b Clinical Trial of BST-236 as a First-Line Treatment of Acute Myeloid Leukemia
July 21, 2018 - First major study comparing robotic to open surgery published in The Lancet
July 21, 2018 - ADHD medications may fail to improve cognition in healthy college students, study shows
July 21, 2018 - Intervention program that includes a personalized app could benefit teens with suicidal thoughts
July 21, 2018 - Researchers identify new compound that protects against neurodegeneration
July 21, 2018 - Gene therapy may hold potential to treat people with spinal cord injuries
July 21, 2018 - FDA Approves Nivestym (filgrastim-aafi), a Biosimilar to Neupogen
July 21, 2018 - Surgeons have substantial impact on genetic testing in breast cancer patients who need it
Post-CABG Afib Associated with Minimal Stroke Risk

Post-CABG Afib Associated with Minimal Stroke Risk

image_pdfDownload PDFimage_print

Action Points

  • Note that this observational study found that the risk of stroke was lower among patients with atrial fibrillation that developed after CABG compared to those who developed atrial fibrillation via other mechanisms.
  • Be aware this raises the question of whether anticoagulation should even be initiated for atrial fibrillation after CABG — a large clinical trial may be needed.

New-onset atrial fibrillation after coronary artery bypass grafting (CABG) surgery was associated with a lower, long-term thromboembolic risk than seen with nonsurgical, nonvalvular AF (NVAF), an observational study found.

The risk of thromboembolism — ischemic stroke, transient cerebral ischemia, and thrombosis or embolism in peripheral arteries — was lower in the postoperative AF (POAF) group than in the NVAF group (18.3 versus 29.7 events per 1,000 person-years; adjusted HR 0.67, 95% CI 0.55-0.81, P<0.001), Jawad Butts, MD, of Rigshospitalet Copenhagen University Hospital, and colleagues reported online March 28 in JAMA Cardiology.

This lower risk was despite substantially lower initiation of oral anticoagulation therapy within 30 days post-discharge in POAF (8.4%) compared with NVAF (42.9%).

In fact, patients who developed POAF following CABG had a statistically similar risk for vessel obstruction due to blood clots as patients who remained in sinus rhythm (adjusted HR 1.11, 95% CI 0.94-1.32, P<0.24).

The study is among the first to examining the long-term risk of thromboembolism associated with POAF following CABG, which occurs in 11% to 40% of patients, according to the researchers.

“Our data do not support the notion that new-onset POAFs should be regarded as similar to primary NVAF in terms of long-term thromboembolic risk,” wrote

The researchers noted that while oral anticoagulation clearly reduces stroke and systemic embolism risk in patients with NVAF, “data on stroke prophylaxis in new-onset POAF after CABG are lacking, and international guidelines on the management of patients with AF do not provide clear recommendations on this issue.”

Anticoagulation therapy during follow-up was associated with a lower risk of thromboembolic events in both patients with POAF (adjusted HR, 0.55, 95% CI, 0.32-0.95; P=0.03) and NVAF (adjusted HR, 0.59, 95% CI, 0.51-0.68; P<0.001) compared with patients who did not receive any anticoagulation therapy.

However, “no causal inferences can be made from the analysis on the effectiveness of oral anticoagulation (OAC) therapy for the prevention of thromboembolism in the two cohorts, although these data suggest that therapy is associated with a similar lower thromboembolic risk among groups,” the researchers cautioned.

Butts and colleagues used data from a clinical cardiac surgery database and nationwide patient registries in Denmark to identify patients undergoing first-time CABG surgery who developed new-onset POAF during a 15-year period beginning in 2000.

Each of those patients was matched by age, sex, CHA2DS2-VASc score and year of diagnosis to four patients with nonsurgical NVAF. In all, 2,108 post CABG patients who developed POAF were matched with 8,432 patients with NVAF.

Study limitations included the possibility of residual confounding associated with the observational design.

The study is not the first to suggest that new-onset AF following cardiac surgery poses a lower risk for stroke than traditional AF. Separate research published in 2014 by Whitlock et al. and Gialdini et al. also showed a lower risk for blood clots and stroke in patients who developed POAF.

The findings “have important implications for how clinicians should treat patients with this common problem,” Jeff Healey, MD, of McMaster University, Ontario, Canada, and colleagues, wrote in an invited commentary published with the study.

“It is likely that some AF following cardiac surgery is indeed transient and caused by inflammation, while in other cases, it is typical clinical AF in an at-risk individual that happens to receive a diagnosis for the first time in the postoperative setting,” they wrote, adding that it is not yet possible to distinguish between the two groups.

They concluded that given the observed lower risk for stroke associated with POAF in the three cohort studies and the low rate of oral anticoagulant use in the post-CABG AF setting, “there is clinical equipoise regarding the need for long-term oral anticoagulation therapy in this setting.”

“A large clinical trial would be invaluable to help resolve this uncertainty. Until such time, clinicians must use their best judgment regarding the need for long-term anticoagulation therapy,” they wrote.

The researchers reported no funding source nor disclosures of conflict of interest within the scope of this study.

Healey disclosed research grants from Bristol-Myers Squibb and Pfizer.

  • Reviewed by
    F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner

2018-03-28T14:45:00-0400

Tagged with:

About author

Related Articles