Breaking News
April 21, 2018 - Developing cooking skills as young adult may have long-term health benefits
April 21, 2018 - Study compares survival outcomes of different drugs for type 2 diabetes
April 21, 2018 - More Than 40 Percent of Americans Breathe Dirty Air: Report
April 21, 2018 - Obstructive sleep apnea – Genetics Home Reference
April 21, 2018 - More evidence shows exposure to traffic and outdoor air pollution increases risk of asthma
April 21, 2018 - Novel gold nanoparticle technology could guide cancer treatment in real-time
April 21, 2018 - News coverage of Ebola impacted public’s perception on disease and survivors
April 21, 2018 - S.Africa’s DIY battle against HIV
April 21, 2018 - Children with autism have gastrointestinal and immune system deregulation, research finds
April 21, 2018 - Human brain processes sight and sound in the same way, shows study
April 21, 2018 - Evolutionary history of tumor helps predict severity of prostate cancer
April 21, 2018 - Pepper plant metabolizes antibiotic in personal care products
April 21, 2018 - Tradeshow Talks with Integra
April 21, 2018 - EPFL becomes part of Chan Zuckerberg’s project to develop Human Cell Atlas
April 21, 2018 - Pfizer Announces Positive Topline Results From Phase 3 ATTR-ACT Study Of Tafamidis In Patients With Transthyretin Cardiomyopathy
April 21, 2018 - Breaking through the HIV vaccine ‘logjam’
April 21, 2018 - IntelliCyt introduces new QSol buffer to enable robust, consistent sampling
April 21, 2018 - Scientists publish comprehensive lineage tree of whole adult animal in Science journal
April 21, 2018 - Innovative method based on FluidFM technology could revolutionize biological research
April 21, 2018 - Americans world’s biggest TV addicts, watching four hours a day
April 21, 2018 - Investigational drug may help increase protein levels in babies with spinal muscular atrophy
April 21, 2018 - Study shows distinctions between age groups in predicting and responding to stress at home
April 21, 2018 - Aziyo Biologics, BIOTRONIK enter into US co-distribution agreement
April 21, 2018 - Opiate Use Linked to Early Mortality in IBD Patients
April 21, 2018 - Online ads help pregnant smokers quit
April 21, 2018 - Opioid pain medications may not be safe for hemodialysis patients
April 21, 2018 - Rare variants in non-coding DNA inherited from parents heighten autism risk
April 21, 2018 - A needleless glucose monitor for diabetes patients
April 21, 2018 - BD introduces new informatics and automation solutions for clinical laboratories
April 21, 2018 - Turn Chores Into a Fitness Routine
April 21, 2018 - DNA methylation plays key role in stem cell differentiation
April 21, 2018 - Scientists find link between soil metals and cancer mortality
April 21, 2018 - Experts discuss implications of low calcium intake in global population
April 21, 2018 - GNA Biosolutions to display Pharos V8 Laser PCR instrument at Analytica trade fair
April 21, 2018 - People with vitamin D deficiency may be at greater risk of diabetes
April 21, 2018 - Study findings could open new possibilities for treating cancer with adenovirus
April 21, 2018 - People who use medical marijuana have higher rates of prescription drug use, study finds
April 21, 2018 - Study debunks ‘myth’ that strenuous exercise dampens immunity
April 21, 2018 - FDA approves marijuana based medication for epilepsy treatment
April 21, 2018 - Researchers find novel genes for longevity in mammals
April 21, 2018 - GNA Biosolutions and project partners launch new research project to develop TB diagnostic platform for POC applications
April 21, 2018 - $2 million funding boosts progress of UAB biomedical startup
April 21, 2018 - Scientists identify gene responsible for evolution of recombination rates
April 21, 2018 - UConn researchers develop new composite for healing broken load-bearing bones
April 21, 2018 - Study examines how higher-order gene combinations help maintain normal cell physiology
April 21, 2018 - Study challenges use of whole-brain radiation for small-cell lung cancer patients with brain metastases
April 21, 2018 - Researchers discover blood biomarkers that may help detect, confirm mild traumatic brain injury
April 21, 2018 - People who become physically active after heart attack more likely to live longer, shows research
April 21, 2018 - CPRIT awards $2 million grant to push forward breast cancer research in West Texas
April 21, 2018 - Unhealthy diet damages the development of immature fat cells, study shows
April 21, 2018 - Consumption of protein supplements with meals may provide better weight control
April 21, 2018 - 4 Types of Foods to Help Boost Your Memory
April 21, 2018 - How did gonorrhea become a drug-resistant superbug?
April 21, 2018 - DePuy Synthes announces clinical results related to use of CORAIL Hip System Femoral Stems
April 21, 2018 - New initiative launched to support goals of Human Cell Atlas
April 20, 2018 - Teen patient gets a new lease on life
April 20, 2018 - Cancer Australia launches new framework to improve outcomes for lung cancer patients
April 20, 2018 - ‘Gut-on-a-chip’ model recreates intestinal matrix critical for nutrient absorption
April 20, 2018 - Researchers develop new drug-testing platform for epilepsy
April 20, 2018 - FDA Alert: NxtGen Botanicals Maeng Da Kratom by NGB Corp.: Recall
April 20, 2018 - Pelizaeus-Merzbacher-like disease type 1 – Genetics Home Reference
April 20, 2018 - Tick-borne diseases reach epidemic levels, panel says
April 20, 2018 - A potential “male pill” without side effects
April 20, 2018 - Researchers discover new information related to rare form of leukemia
April 20, 2018 - Researchers find crucial links between dopamine and avoidance behavior
April 20, 2018 - UGA scientist creates system for efficient detection of foodborne pathogens
April 20, 2018 - Social Support of Autonomy Tied to Better Glycemic Control in DM
April 20, 2018 - Study reports use of nutritional ketosis with mobile app intervention could reverse Type 2 diabetes
April 20, 2018 - New microscopy techniques allow quasi-biochemical studies on living T cells
April 20, 2018 - Study shows connection between muscular strength and brain health
April 20, 2018 - Ecolab introduces Life Sciences cleanroom program in North America
April 20, 2018 - Normal weight people with fat belly may have more chance of heart problems
April 20, 2018 - Male fruit flies like sex and alcohol
April 20, 2018 - Meditation could help reduce anxiety levels and some heart health risk factors
April 20, 2018 - Improving job prospects unlikely to control opioid epidemic
April 20, 2018 - Skin Sensor Might Someday Track Alcoholics’ Booze Intake
April 20, 2018 - The relevance of GABA for diabetes highlighted in two new studies
April 20, 2018 - Novel method enables fast and noninvasive assessment of tumor status
April 20, 2018 - IU psychologist receives NIH grant to study earliest phases of language learning in children
April 20, 2018 - Walking fast lowers risk of hospitalization in heart patients, shows study
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