Postoperative AF as likely to cause stroke as non-operative AF, study.

In a weighted analysis, the risk of stroke or TIA was no different between those whose AF appeared after surgery and those who presented outside of the surgical setting. There were also no differences in the risks of cardiovascular and all-cause death. However, patients with postoperative AF had a 13.4% lower risk of recurrent AF.

Interestingly, the authors note that "half of the anticoagulant-eligible patients with postoperative AF never received an anticoagulant prescription."

The findings underscore the notion that postoperative AF "should not be considered a transient, benign phenomenon," authors Siontis et al write. "Rather, it is an arrhythmia that seems to portend similar thromboembolic risks as AF diagnosed outside of the operative setting."

The bigger question that is still an unknown is: should we treat people who have postoperative A-Fib with anticoagulation even from the get-go?

Although randomised data will shed further light on this issue, but an important takeaway from this study is that any post-operative AF is not to be considered benign. An EP follow-up, estimation of CHA2DS2VASc score and associated bleeding risk can guide better decision making regarding anticoagulant therapy.

Source: Annals of Internal Medicine

Siontis KC, Gersh BJ, Weston SA, Jiang R, Roger VL, Noseworthy PA, Chamberlain AM. Associations of Atrial Fibrillation After Noncardiac Surgery With Stroke, Subsequent Arrhythmia, and Death : A Cohort Study. Ann Intern Med. 2022 Jul 26.