Oral anticoagulants in de novo atrial fibrillation after cardiac surgery: a systematic review of the literature and meta-analysis: revisión sistemática de la literatura y metaanálisis

Introduction: Postoperative atrial fibrillation (POAF) after cardiac surgery is a frequent complication associated with higher risk of thromboembolism. The best anticoagulation strategy in patients with postoperative atrial fibrillation of more than 48 hours is still uncertain. Objective: Evaluate the results of treatment with direct oral anticoagulants and warfarin in postoperative atrial fibrillation patients in terms of ischemic events, bleeding, mortality, and cost-effectiveness in this population. Method: A systematic review of the literature and meta-analysis were conducted including information from studies comparing these treatments. The GRADE system was used for grading the quality of evidence. Effect summary odds ratios (OR) and 95% confidence intervals (CI) were obtained by means of the random effect model. Results: From 752 studies, 3 randomized clinical trials and 2 observational studies were included. Our data revealed a decrease of ischemic events in patients receiving direct oral anticoagulants as compared with warfarin (OR: 0.59; CI 95%: 0.36-0.97; p = 0.045). There were not statistical differences in mortality, bleeding and cost-effectiveness. Conclusions: Our findings suggest that direct oral anticoagulants might decrease the risk of ischemic events in postoperative atrial fibrillation patients. However, further randomized clinical trials are needed to define the choice of optimal treatment.