Antithrombotic therapy of patients with atrial fibrillation discharged after major non-cardiac surgery. 1-year follow-up. Sub-analysis of PRAGUE 14 study

Martina Ondrakova, Zuzana Motovska, Petr Waldauf, Jiri Knot, Lukas Havluj, Lukas Bittner, Radek Bartoska, Robert Gűrlich, Martin Krbec, Valer Dzupa, Robert Grill, Petr Widimsky, Martina Ondrakova, Zuzana Motovska, Petr Waldauf, Jiri Knot, Lukas Havluj, Lukas Bittner, Radek Bartoska, Robert Gűrlich, Martin Krbec, Valer Dzupa, Robert Grill, Petr Widimsky

Abstract

Background: The study investigated the discharge antithrombotic medication in patients with atrial fibrillation (AF) after major non-cardiac surgery and the impact on one-year outcomes.

Methods: A subgroup of 366 patients (mean age 75.9±10.5 years, women 42.3%, acute surgery 42.9%) undergoing major non-cardiac surgery and having any form of AF (30.6% of the total population enrolled in the PRAGUE-14 study) was followed for 1 year.

Results: Antithrombotics (interrupted due to surgery) were resumed until discharge in 51.8% of patients; less frequently in men (OR 0.6 (95% CI 0.95 to 0.35); p = 0.029), and in patients undergoing elective surgery (OR 0.6 (95% CI 0.91 to 0.33); p = 0.021). Dual antiplatelet therapy was resumed more often (91.7%) in comparison to aspirin monotherapy (57.3%; p = 0.047), and vitamin K antagonist (56.3%; p = 0.042). Patients with AF had significantly higher one-year mortality (22.1%) than patients without AF (14.1%, p = 0.001). The causes of death were: ischaemic events (32.6% of deaths), bleeding events (8.1%), others (N = 51; 59.3%, 20 of them died due to cancer). Non-reinstitution of aspirin until discharge was associated with higher one-year mortality (17.6% vs. 34.8%; p = 0.018).

Conclusion: Preoperatively interrupted antithrombotics were re-administrated at discharge only in half of patients with AF, less likely in male patients and those undergoing elective surgery. The presence of AF was recognized as a predictor of one-year mortality, especially if aspirin therapy was not resumed until discharge.

Trial registration: ClinicalTrials.gov NCT01897220.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Antithrombotic treatment re-administration in the…
Fig 1. Antithrombotic treatment re-administration in the period of up to 1 year after discharge.
Fig 2. Re-administration of antithrombotic drugs according…
Fig 2. Re-administration of antithrombotic drugs according to surgery departments.
Fig 3. One-year survival of patients with…
Fig 3. One-year survival of patients with AF after non-cardiac surgery.
Fig 4. One-year survival of patients on…
Fig 4. One-year survival of patients on aspirin after non-cardiac surgery.

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