Anticoagulation and amiodarone for new atrial fibrillation after coronary artery bypass grafting: Prescription patterns and 30-day outcomes in the United States and Canada

Matos, Jason; McIlvaine, Susan; Grau‐Sepulveda, Maria V.; Jawitz, Oliver K.; Brennan, J. Matthew; Khabbaz, Kamal R.; Sellke, Frank W.; Yeh, Robert W.; Zimetbaum, Peter

doi:10.1016/j.jtcvs.2020.01.077

Cited by 28 publications

(30 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Atrial fibrillation (AF) occurs in 32% of patients post‐CABG with a high recurrence rate 63 . There's controversy about the role of anticoagulation in preventing strokes in these patients, with some studies suggesting concomitant warfarin and antiplatelet therapy as being beneficial, and others showing increased bleeding and no difference in stroke at 30 days with anticoagulation 64,65 . There is an ongoing prospective phase 3 trial evaluating the effectiveness of adding oral anticoagulation therapy to antiplatelet therapy in post‐CABG patients with new onset AF due for completion by 2023 66…”

Section: Anticoagulant Therapymentioning

confidence: 99%

Anticoagulation and antiplatelet therapy post coronary artery bypass surgery

et al. 2021

View full text Add to dashboard Cite

Background Coronary artery bypass grafting (CABG) is the gold standard treatment for patients with multivessel coronary heart disease. Although its use has proven long‐term survival benefits, there is a relative degree of graft failure which increases morbidity and mortality rates. Discussion This review discusses clinical outcomes following antiplatelet and anticoagulant therapy after CABG. There is wide variation of evidence about the use of clopidogrel or ticagrelor to aspirin postoperatively in relation to improving graft patency rates or clinical outcomes over the use of aspirin alone. These dual therapies may have significant protective effects in patients undergoing off‐pump CABG. Recent studies suggest that superior outcomes may be attained by combining prasugrel with aspirin. Further research is needed to evaluate this, as well as compare the effectiveness of different dual antiplatelet regimens. There is weak evidence for post‐CABG anticoagulation, with warfarin and rivaroxaban providing no protection against graft failure but decreasing long‐term major adverse cardiac events. Anticoagulation seems to be indicated only in post‐CABG patients at high risk of future ischemic events. Conclusion The use of dual anti‐platelet therapy post coronary artery bypass surgery needs further research. Potentially, selective patient groups will benefit more from the addition of thienopyridine antiplatelets or anticoagulants to aspirin after CABG.

show abstract

Section: Anticoagulant Therapymentioning

confidence: 99%

Anticoagulation and antiplatelet therapy post coronary artery bypass surgery

et al. 2021

View full text Add to dashboard Cite

show abstract

“…2,3 Until now, however, adherence, or lack thereof, to the recommendations was not known. Matos and colleagues 1 present a thought-provoking study that will certainly inform future investigations.…”

mentioning

confidence: 97%

“…In this issue of the Journal, Matos and colleagues 1 report the prescribing patterns of anticoagulation and amiodarone in patients with new-onset atrial fibrillation (AF) after coronary artery bypass grafting (CABG), as well as their early postoperative outcomes. Practice guidelines include recommendations for management of postoperative AF.…”

mentioning

confidence: 99%

“…Unfortunately, patients' discharge rhythm data are missing from the study of Matos and colleagues. 1 Consequently, we do not know whether patients were discharged without anticoagulation because they were in sinus rhythm before discharge or because of concerns about anticoagulation. Patients who were discharged on a regimen of anticoagulation and amiodarone had a lower rate of stroke than did those discharged on a regimen of amiodarone alone.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Commentary: A step toward solving a stubborn problem…maybe

Langer¹,

Vlahakes²

2021

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

“…These findings are inconsistent. Indeed, even in patients with postoperative atrial fibrillation, the use of warfarin has recently been associated with increased mortality and major bleeding compared with antiplatelet therapy alone 2 . This in part lead to the initiation of a large scale multicenter trial sponsored by the Cardiothoracic Surgery Network of the National Heart Lung and Blood Institute to address anticoagulation after CABG in the setting of postoperative atrial fibrillation.…”

mentioning

confidence: 99%

Secondary prevention after coronary artery bypass grafting: Anticoagulation and antiplatelet therapy is only one factor

Sellke

2021

J Card Surg

Self Cite

View full text Add to dashboard Cite

Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel/ticagrelor/prasugrel does not lead to improved graft patency rates or clinical outcomes after coronary artery bypass grafting (CABG) over aspirin monotherapy, at least for on pump CABG. The protective effects of DAPT tended to be observed to be greater extent in patients undergoing off pump CABG. In general, the addition of the potent thienopyridines increased the risk of major bleeding, although the incidence of major bleeding is relatively low after either on pump or off pump surgical revascularization. There is a lack of evidence that anticoagulation post‐CABG provides any protection against graft failure, but it may decrease the incidence of major adverse cardiovascular events. However, antiplatelet and anti thrombotic therapy after CABG is only one component of secondary prevention that needs to be taken into consideration when optimizing the long‐term outcomes of patients after CABG.

show abstract

Anticoagulation and amiodarone for new atrial fibrillation after coronary artery bypass grafting: Prescription patterns and 30-day outcomes in the United States and Canada

Cited by 28 publications

References 20 publications

Anticoagulation and antiplatelet therapy post coronary artery bypass surgery

Anticoagulation and antiplatelet therapy post coronary artery bypass surgery

Commentary: A step toward solving a stubborn problem…maybe

Secondary prevention after coronary artery bypass grafting: Anticoagulation and antiplatelet therapy is only one factor

Contact Info

Product

Resources

About