Abstract
The evidence for use of direct oral anticoagulants (DOACs) in the management of post-operative cardiac surgery atrial fibrillation is limited and mostly founded on clinical trials that excluded this patient population. We performed a systematic review and meta-analysis of clinical trials and observational studies to evaluate the hypothesis that DOACs are safe compared to warfarin for the anticoagulation of patients with post-operative cardiac surgery atrial fibrillation. We searched PubMed, EMBASE, Web of Science, clinicaltrials.gov, and the Cochrane Library for clinical trials and observational studies comparing DOAC with warfarin in patients ≥18 years old who had post-cardiac surgery atrial fibrillation. Primary outcomes included stroke, systemic embolization, bleeding, and mortality. We performed a random-effects meta-analysis of all outcomes. The meta-analysis for the primary outcomes showed significantly lower risk of stroke with DOAC use (6 studies, 7143 patients, RR 0.64; 95% CI 0.50-0.81, I2: 0.0%) compared to warfarin, a trend towards lower risk of systemic embolization (4 studies, 7289 patients, RR 0.64, 95% CI 0.41-1.01, I2: 31.99%) and similar risks of bleeding (14 studies, 10182 patients, RR 0.91; 95% CI 0.74-1.10,...Continue Reading
References
Sep 1, 1986·Controlled Clinical Trials·R DerSimonian, N Laird
Oct 6, 1997·BMJ : British Medical Journal·M EggerC Minder
May 2, 2000·JAMA : the Journal of the American Medical Association·D F StroupS B Thacker
Jul 20, 2002·Anesthesiology·John G LaffeyDavy C H Cheng
Sep 20, 2005·Chest·Andrew E EpsteinUNKNOWN American College of Chest Physicians
Feb 26, 2008·Journal of the American College of Cardiology·Najmeddine EchahidiPatrick Mathieu
Feb 17, 2009·Heart·Robert W Rho
Jul 22, 2009·PLoS Medicine·David MoherUNKNOWN PRISMA Group
Sep 1, 2009·The New England Journal of Medicine·Stuart J ConnollyUNKNOWN RE-LY Steering Committee and Investigators
Oct 2, 2009·Journal of Thrombosis and Haemostasis : JTH·S SellengA Greinacher
Aug 31, 2010·European Heart Journal·A John CammFrans H Rutten
Aug 13, 2011·The New England Journal of Medicine·Manesh R PatelUNKNOWN ROCKET AF Investigators
Aug 30, 2011·The New England Journal of Medicine·Christopher B GrangerUNKNOWN ARISTOTLE Committees and Investigators
Sep 21, 2012·Journal of Cardiothoracic Surgery·Solveig HelgadottirTomas Gudbjartsson
Sep 30, 2015·Clinical Cardiology·Wengen ZhuKui Hong
Oct 21, 2015·American Journal of Surgery·Eric AndersonCornelius Dyke
Nov 26, 2015·Anesthesiology·Miklos D KertaiManuel L Fontes
Feb 20, 2016·Drugs in R&D·André Rodrigues DurãesRoque Aras
Dec 6, 2016·JACC. Cardiovascular Interventions·Julia SeegerJochen Wöhrle
Feb 18, 2017·Circulation·Anthony P CarnicelliUNKNOWN ENGAGE AF-TIMI 48 Investigators
Apr 4, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jason W GreenbergSpencer J Melby
Mar 27, 2018·The Annals of Thoracic Surgery·David M ShahianSean M O'Brien
Apr 13, 2018·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Nicolas A GeisRaffi Bekeredjian
Aug 3, 2018·The Thoracic and Cardiovascular Surgeon·Kennosuke YamashitaDerek J Dosdall
Nov 9, 2018·The Canadian Journal of Cardiology·Jason G AndradeUNKNOWN CCS Atrial Fibrillation Guidelines Committee
Jan 20, 2019·The American Journal of Cardiology·Norman MangnerAxel Linke
Mar 25, 2019·Clinical Cardiology·Patricia O GuimarãesChristopher B Granger
Apr 24, 2019·Journal of Cardiac Surgery·Pey-Jen YuAlan Hartman
Jun 17, 2019·JACC. Cardiovascular Interventions·David JochheimJulinda Mehilli
Nov 11, 2019·The Journal of Thoracic and Cardiovascular Surgery·Jared P BellerGorav Ailawadi
Nov 19, 2019·Clinical Therapeutics·Vincenzo RussoAntonio D'Onofrio