Key result
DOACs show no significant difference in bleeding risk versus VKAs in postoperative AF.
Why the study?
Atrial fibrillation after cardiac surgery is common and associated with stroke, prolonged hospitalization, and mortality, yet the optimal oral anticoagulant in this setting remains uncertain.
Do direct oral anticoagulants reduce the risk of any bleeding compared with vitamin K antagonists in adults requiring oral anticoagulation for atrial fibrillation after cardiac surgery?
Meta-Analysis (n=302)
Do direct oral anticoagulants reduce the risk of any bleeding compared with vitamin K antagonists in adults requiring oral anticoagulation for atrial fibrillation after cardiac surgery?
In adults with atrial fibrillation after cardiac surgery, pooled randomized trial data show no significant difference in overall bleeding rates between direct oral anticoagulants and warfarin, though total sample size across trials remains small.
Comparable bleeding with DOACs versus VKAs in postoperative AF; small pooled RCT sample leaves efficacy and optimal choice open.
Atrial fibrillation after cardiac surgery is common and is associated with stroke, prolonged hospitalization, and mortality; yet, the optimal oral anticoagulant in this setting remains uncertain. We performed a systematic review and meta-analysis comparing direct oral anticoagulants (DOACs) with vitamin K antagonists (VKAs) in adults requiring oral anticoagulation for atrial fibrillation after cardiac surgery. PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from inception through August 2026 for randomized controlled trials. The primary outcome was any bleeding; secondary outcomes were stroke or transient ischemic attack, systemic embolism, major bleeding, intracranial hemorrhage, reoperation, and length of hospital stay. Odds ratios (ORs) and mean differences (MDs) were pooled with random-effects models, risk of bias was assessed with the Cochrane Risk of Bias 2 tool, and certainty of evidence was rated with GRADE. Five randomized trials including 302 patients (153 DOACs and 149 warfarin) were included; rivaroxaban was tested in 3 trials, and apixaban and dabigatran in 1 trial each. Any bleeding did not differ significantly between DOACs and VKAs (9.2% vs 8.1%; OR, 1.24; 95% confidence interval [CI], 0.39-3.99).
No takes yet. Share an insight, caveat, or question.
Al-Harrasi et al. (2026) conducted a meta-analysis in Atrial fibrillation after cardiac surgery (n=302). Direct oral anticoagulants (rivaroxaban, apixaban, dabigatran) vs. Vitamin K antagonists (warfarin) was evaluated on Any bleeding (OR 1.24, 95% CI 0.39-3.99). Direct oral anticoagulants did not significantly differ from vitamin K antagonists for any bleeding in postoperative atrial fibrillation (9.2% vs 8.1%; OR 1.24; 95% CI 0.39-3.99).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: