Trends and Outcomes of Anticoagulation for Post‐Operative Atrial Fibrillation After Coronary Artery Bypass Graft

BACKGROUND: The benefit of oral anticoagulation (OAC) in patients with new-onset postoperative atrial fibrillation (POAF) after coronary bypass grafting remains uncertain. The 2023 American Heart Association (AHA) and the American College of Cardiology (ACC) guidelines recommend 60 days of anticoagulation for POAF, whereas management was previously left to the physician's discretion. The aim of this study is to identify the most effective anticoagulant regimens for reducing stroke rates in POAF patients after coronary artery bypass grafting (CABG). METHODS: Using the Epic Cosmos database, we included all US patients who underwent CABG without concomitant aortic/mitral valve replacement (MVR) from 2017 to 2023. Primary outcomes include demographics of POAF/non-POAF patients and complication rates among patients without anticoagulation, on direct oral anticoagulation (DOAC), or on warfarin. RESULTS: Of the 147,546 patients studied, 7.6% (11,336) developed POAF. At 60 days, the use of OAC for POAF was associated with a decrease in all-cause mortality without any difference in thromboembolism rates. At 12 months, there was no difference between all-cause mortality and thromboembolism rates between the OAC and the no anticoagulation (NA) cohorts. CONCLUSIONS: The benefit of long-term anticoagulation of POAF following CABG with warfarin or DOAC remains unclear, as there was no reduction in thromboembolic events with anticoagulation despite a reduction in all-cause mortality at 60 days. No significant reduction in thromboembolic events or all-cause mortality was exhibited at 1 year. Thus, the benefit of long-term anticoagulation of POAF following CABG with warfarin or DOAC remains unclear.