Key result
Long-term oral anticoagulation linked to ~25% lower mortality in new-onset AF during acute MI.
Why the study?
Randomized trials evaluating anticoagulation mostly excluded patients with new-onset AF after AMI, leaving the efficacy and bleeding risk of long-term OAC therapy uncertain.
Does long-term oral anticoagulant therapy reduce mortality and stroke in patients with new-onset atrial fibrillation during acute myocardial infarction?
Meta-Analysis (n=7,158)
Does long-term oral anticoagulant therapy reduce mortality and stroke in patients with new-onset atrial fibrillation during acute myocardial infarction?
Long-term oral anticoagulation in patients developing new-onset atrial fibrillation during an acute myocardial infarction reduces all-cause mortality by 25% without a significant increase in major bleeding, though the data are largely based on warfarin rather than DOACs.
May support OAC consideration in post-MI new-onset AF; leaves open DOAC efficacy and need for RCTs.
BACKGROUND: New-onset atrial fibrillation (NOAF) is observed in 2%-21% of patients with acute myocardial infarction (AMI) and is associated with adverse outcomes, including increased mortality, heart failure, and stroke. Despite guideline recommendations the long-term role of oral anticoagulant (OAC) therapy in this population remains unclear. Most randomized clinical trials evaluating anticoagulation excluded patients with NOAF following AMI, creating a gap in high-quality evidence. Whether long-term OAC therapy improves prognosis without excess bleeding risk in this setting remains uncertain. We hypothesized that OAC use reduces mortality in patients with NOAF complicating AMI. AIM: To determine the efficacy and safety of long-term OAC therapy in patients with NOAF during AMI. METHODS: We conducted a systematic review of the PubMed and eLIBRARY databases through March 2025 following predefined patient, intervention, comparison, outcome criteria. Eligible observational studies included patients with AMI and newly detected atrial fibrillation during the index event who were prescribed OAC therapy with available outcome data. Methodological quality was evaluated using the Quality in Prognosis Studies tool. Pooled hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using a random-effects model. Primary outcomes were all-cause mortality, ischemic stroke, and major bleeding. The cohorts largely reflected vitamin K antagonist-based therapy with clopidogrel. Stroke prevention benefit was not statistically significant, and data specific to direct OACs remain sparse. CONCLUSION: Long-term OAC therapy after AMI with NOAF reduced mortality without consistent bleeding increase though findings mainly reflect warfarin-era practice and not direct OACs.
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Pereverzeva et al. (2026) conducted a meta-analysis in New-onset atrial fibrillation during acute myocardial infarction (n=7,158). Oral anticoagulant therapy vs. No oral anticoagulant therapy was evaluated on All-cause mortality (HR 0.75, 95% CI 0.64-0.90, p=0.001). Long-term oral anticoagulant therapy was associated with a 25% reduction in all-cause mortality (HR 0.75) in patients with new-onset atrial fibrillation during acute myocardial infarction.
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