Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery
Issued Date
2024-01-01
Resource Type
ISSN
10788956
eISSN
1546170X
Scopus ID
2-s2.0-85204698531
Pubmed ID
39179854
Journal Title
Nature Medicine
Rights Holder(s)
SCOPUS
Bibliographic Citation
Nature Medicine (2024)
Suggested Citation
Azimaraghi O., Rudolph M.I., Wongtangman K., Borngaesser F., Doehne M., Ng P.Y., von Wedel D., Eyth A., Zou F., Tam C., Sauer W.J., Kiyatkin M.E., Houle T.T., Karaye I.M., Zhang L., Schaefer M.S., Schaefer S.T., Himes C.P., Grimm A.M., Nafiu O.O., Mpody C., Suleiman A., Stiles B.M., Di Biase L., Garcia M.J., Ramachandran S., Scheffenbichler F.T., Ramishvili T., Pulverenti T., Luedeke C.M., Leff J., Latib M.A., Im J.J., Ganz-Lord F., Forest S.J., DeRose J.J., Bald A., Bhatt D.L., Eikermann M. Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery. Nature Medicine (2024). doi:10.1038/s41591-024-03206-0 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/101407
Title
Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery
Author(s)
Azimaraghi O.
Rudolph M.I.
Wongtangman K.
Borngaesser F.
Doehne M.
Ng P.Y.
von Wedel D.
Eyth A.
Zou F.
Tam C.
Sauer W.J.
Kiyatkin M.E.
Houle T.T.
Karaye I.M.
Zhang L.
Schaefer M.S.
Schaefer S.T.
Himes C.P.
Grimm A.M.
Nafiu O.O.
Mpody C.
Suleiman A.
Stiles B.M.
Di Biase L.
Garcia M.J.
Ramachandran S.
Scheffenbichler F.T.
Ramishvili T.
Pulverenti T.
Luedeke C.M.
Leff J.
Latib M.A.
Im J.J.
Ganz-Lord F.
Forest S.J.
DeRose J.J.
Bald A.
Bhatt D.L.
Eikermann M.
Rudolph M.I.
Wongtangman K.
Borngaesser F.
Doehne M.
Ng P.Y.
von Wedel D.
Eyth A.
Zou F.
Tam C.
Sauer W.J.
Kiyatkin M.E.
Houle T.T.
Karaye I.M.
Zhang L.
Schaefer M.S.
Schaefer S.T.
Himes C.P.
Grimm A.M.
Nafiu O.O.
Mpody C.
Suleiman A.
Stiles B.M.
Di Biase L.
Garcia M.J.
Ramachandran S.
Scheffenbichler F.T.
Ramishvili T.
Pulverenti T.
Luedeke C.M.
Leff J.
Latib M.A.
Im J.J.
Ganz-Lord F.
Forest S.J.
DeRose J.J.
Bald A.
Bhatt D.L.
Eikermann M.
Author's Affiliation
Medizinische Fakultät
Siriraj Hospital
Nationwide Children’s Hospital
Queen Mary Hospital Hong Kong
Hofstra University
Charité – Universitätsmedizin Berlin
Heinrich-Heine-Universität Düsseldorf
Montefiore Medical Center
Universität Oldenburg
Icahn School of Medicine at Mount Sinai
Universität Ulm
Universitätsklinikum Essen
The University of Hong Kong
Harvard Medical School
Albert Einstein College of Medicine
Siriraj Hospital
Nationwide Children’s Hospital
Queen Mary Hospital Hong Kong
Hofstra University
Charité – Universitätsmedizin Berlin
Heinrich-Heine-Universität Düsseldorf
Montefiore Medical Center
Universität Oldenburg
Icahn School of Medicine at Mount Sinai
Universität Ulm
Universitätsklinikum Essen
The University of Hong Kong
Harvard Medical School
Albert Einstein College of Medicine
Corresponding Author(s)
Other Contributor(s)
Abstract
The role of antithrombotic therapy in the prevention of ischemic stroke after non-cardiac surgery is unclear. In this study, we tested the hypothesis that the association of new-onset postoperative atrial fibrillation (POAF) on ischemic stroke can be mitigated by postoperative oral anticoagulation therapy. Of 251,837 adult patients (155,111 female (61.6%) and 96,726 male (38.4%)) who underwent non-cardiac surgical procedures at two sites, POAF was detected in 4,538 (1.8%) patients. The occurrence of POAF was associated with increased 1-year ischemic stroke risk (3.6% versus 2.3%; adjusted risk ratio (RRadj) = 1.60 (95% confidence interval (CI): 1.37–1.87), P < 0.001). In patients with POAF, the risk of developing stroke attributable to POAF was 1.81 (95% CI: 1.44–2.28; P < 0.001) without oral anticoagulation, whereas, in patients treated with anticoagulation, no significant association was observed between POAF and stroke (RRadj = 1.04 (95% CI: 0.71–1.51), P = 0.847, P for interaction = 0.013). Furthermore, we derived and validated a computational model for the prediction of POAF after non-cardiac surgery based on demographics, comorbidities and procedural risk. These findings suggest that POAF is predictable and associated with an increased risk of postoperative ischemic stroke in patients who do not receive postoperative anticoagulation.