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What is the optimal anticoagulation management of patients post-cardiac surgery who go into atrial fibrillation?

Department of Cardiothoracic Surgery, Freeman Hospital, Freeman Road, NE7 7DN, Newcastle upon Tyne, UK

^* Corresponding author
joeldunning{at}doctors.org.uk

smnouraei{at}yahoo.co.uk

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether anticoagulation is indicated for patients in atrial fibrillation (AF) following coronary artery bypass grafting. Altogether 166 papers were found using the reported search, of which 10 presented the best evidence to answer the clinical question. In addition the American Heart Association guidelines for management of atrial fibrillation were reviewed. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these papers are tabulated. We conclude that patients post-cardiac surgery require warfarinisation while in atrial fibrillation with an INR of 2–3, and full anticoagulation should be commenced within 48 h of the onset of AF as their risk of stroke is doubled by the onset of AF.

Key Words: Evidence-based medicine; Thoracic surgery; Atrial fibrillation; Anticoagulation; Review