Anticoagulation therapy is necessary for patients who have had cardiac surgery who develop AF to avoid early stroke and death [121]. OAC reduces postoperative mortality rates in patients discharged with POAF. Nevertheless, there is no clear evidence on when to start anticoagulation, and the decision has to be made based on balancing the risks for bleeding and thromboembolisms. Starting early with a therapeutic dose of UFH or LMWH should be considered within 12–48 h after surgery. OAC should commence 48 h after surgery and be maintained for at least 4 weeks according to the CHA₂DS₂-VASc score [17, 122]. Most of the evidence for anticoagulation of POAF has been obtained with VKAs. For patients with mechanical valve prostheses or moderate-to-severe mitral stenosis, VKAs are highly recommended [17]. There is evidence supporting a greater benefit of NOACs over VKA in non-valvular POAF, including patients with a bioprosthetic valve [123, 124].

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Recommendations for prevention in and treatment of patients with atrial fibrillation

a

Class of recommendation.

b

Level of evidence.

c

References.

AF: atrial fibrillation; CHA₂DS₂-VASc: Congestive heart failure, hypertension, age >75 (2 points), diabetes, prior stroke (2 points)–vascular disease, age 65–74, sex category (female); LMWH: low-molecular-weight heparin; OAC: oral anticoagulant; POAF: postoperative atrial fibrillation; UFH: unfractionated heparin.

Open in new tab

Recommendations for prevention in and treatment of patients with atrial fibrillation

a

Class of recommendation.

b

Level of evidence.

c

References.

AF: atrial fibrillation; CHA₂DS₂-VASc: Congestive heart failure, hypertension, age >75 (2 points), diabetes, prior stroke (2 points)–vascular disease, age 65–74, sex category (female); LMWH: low-molecular-weight heparin; OAC: oral anticoagulant; POAF: postoperative atrial fibrillation; UFH: unfractionated heparin.