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Rademacher et al. Vessel Plus 2022;6:39                                    Vessel Plus
               DOI: 10.20517/2574-1209.2021.138



               Review                                                                        Open Access



               Stroke risk and anticoagulation in the setting of

               post-cardiac surgery atrial fibrillation: a systematic
               review of the literature


                                1
                                                1,#
                                                                   2,3
               Nicole Rademacher , Cordell Spellman , G. Hossein Almassi , Moritz C. Wyler von Ballmoos 4
               1
                Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
               2
                Division of cardiothoracic Surgery, Medical College of Wisconsin, 8701 Watertown Plank Rd, Milwaukee, WI 53226, USA.
               3
                Cardiothoracic Surgery, Zablocki VA Medical Center, 5000 W National Avenue, Milwaukee, WI 53295, USA.
               4
                Department of Cardiovascular Surgery, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX 77030, USA.
               #
                Co-first authors.
               Correspondence to: Dr. Moritz C. Wyler von Ballmoos, Department of Cardiovascular Surgery, Houston Methodist DeBakey
               Heart & Vascular Center 6565 Fannin St, Houston, TX 77030, USA. E-Mail: mcwylervonballmoos@houstonmethodist.org
               How to cite this article: Rademacher N, Spellman C, Almassi GH, Wyler von Ballmoos MC. Stroke risk and anticoagulation in the
               setting of post-cardiac surgery atrial fibrillation: a systematic review of the literature. Vessel Plus 2022;6:39.
               https://dx.doi.org/10.20517/2574-1209.2021.138
               Received: 16 Nov 2021  First Decision: 24 Jan 2022  Revised: 16 Feb 2022  Accepted: 3 Mar 2022  Published: 13 Jun 2022
               Academic Editor: Giuseppe Andò   Copy Editor: Haixia Wang  Production Editor: Haixia Wang


               Abstract
               Postoperative atrial fibrillation (POAF) affects up to 50% of patients undergoing cardiac surgery. It remains unclear
               to what extent POAF increases the stroke risk and whether anticoagulation is warranted in this setting. The primary
               objective of this review was to conduct a systematic review of the evidence for a correlation between POAF and
               stroke. Further, we sought to evaluate the published evidence on anticoagulation in the setting of POAF to prevent
               stroke. To this end, we performed a comprehensive literature search to identify studies on POAF in patients
               undergoing cardiac surgery with stroke as an outcome. To date, eight meta-analyses providing pooled estimates of
               the stroke risk associated with POAF in patients undergoing cardiac surgery have been published. The reported
               pooled odds ratios range from 1.36 to 4.09 for unadjusted estimates. Additionally, five studies were identified that
               evaluated the impact of anticoagulation on stroke in the setting of POAF. Of these, three supported the use of
               anticoagulants, and two studies were inconclusive. This systematic review did not find strong supporting evidence
               that POAF is causally related to stroke, despite a strong correlation with comorbidities and all-cause mortality in
               the literature. Available evidence to date suggests an elevated risk of bleeding with no clear reduction in stroke or
               other thromboembolic events when anticoagulation is initiated in the setting of POAF. An upcoming randomized
               clinical  trial  by  the  Cardiothoracic  Surgery  Network  group  will  hopefully  provide  clarification  on  the
               recommendations for anticoagulation in the setting of POAF after cardiac surgery.





                           © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
                           International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
                           adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
               long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
               indicate if changes were made.

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