A Comparative Prospective Observational Study on the Use of Direct Oral Anticoagulants after Cardiac Surgery for the Management of Atrial Fibrillation

Autor: Yoshiki Kitazumi, Keita Kamata, Shunji Osaka, Keito Suzuki, Masashi Tanaka, Akira Sezai, Makoto Taoka
Rok vydání: 2021
Předmět:
Male
Time Factors
Pyridines
Management of atrial fibrillation
030204 cardiovascular system & hematology
chemistry.chemical_compound
0302 clinical medicine
Rivaroxaban
Risk Factors
non-valvular atrial fibrillation
Edoxaban
Atrial Fibrillation
Prospective Studies
Stroke
medicine.diagnostic_test
Gastroenterology
Atrial fibrillation
General Medicine
Middle Aged
Treatment Outcome
Anesthesia
Female
Original Article
Apixaban
Cardiology and Cardiovascular Medicine
cardiac surgery
Partial thromboplastin time
medicine.drug
Pulmonary and Respiratory Medicine
Pyridones
DOAC
Hemorrhage
Drug Administration Schedule
03 medical and health sciences
medicine
Humans
Cardiac Surgical Procedures
Aged
Prothrombin time
anticoagulation therapy
business.industry
medicine.disease
Thiazoles
030228 respiratory system
chemistry
Pyrazoles
Surgery
business
Factor Xa Inhibitors
Zdroj: Annals of Thoracic and Cardiovascular Surgery
ISSN: 2186-1005
1341-1098
DOI: 10.5761/atcs.oa.20-00213
Popis: Purpose Recently, guidelines recommended the use of direct oral anticoagulants (DOACs) for the management of non-valvular atrial fibrillation (NVAF). Postoperative atrial fibrillation (POAF) is the most common post-surgical complication of cardiac surgery, but the efficacy and safety of DOAC for POAF have rarely been investigated. We conducted a prospective observational study to investigate the efficacy and safety of DOAC administered immediately after POAF. Materials and methods In all, 135 patients that experienced POAF after cardiac surgery were treated with a DOAC. Primary endpoints were either bleeding or thromboembolic events. Secondary endpoints included changes in hemoglobin (Hb), prothrombin time (PT), activated partial thromboplastin time (APTT), serum creatinine (sCr), estimated glomerular filtration rate (eGFR), and pleural/pericardial effusion. Results Patients were treated with apixaban (n = 31), edoxaban (n = 87), and rivaroxaban (n = 17). Major bleeding (p = 0.011) and gastrointestinal (GI) bleeding (p = 0.047) were significantly more frequent in the rivaroxaban group. Stroke was observed in one rivaroxaban group patient and none in the other two groups. Conclusion DOAC as anticoagulation therapy for the early intervention of POAF following cardiac surgery is associated with a low incidence of major bleeding; a favorable safety profile and excellent efficacy were demonstrated for DOAC. Furthermore, our results indicate that the safety and efficacy of apixaban and edoxaban are better than rivaroxaban.
Databáze: OpenAIRE
Externí odkaz: