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The Price of Keeping the Rhythm: Increased Bleeding Risk in Patients with Atrial Fibrillation Concurrently Prescribed Amiodarone and Factor Xa Inhibitors
Atrial fibrillation is the most common sustained cardiac arrhythmia affecting nearly 2% of the population of the United States.1 Patients with atrial fibrillation are twice as likely to have a myocardial infarction and five-times as likely to have a stroke.1 Current guidelines recommend antiarrhythmic pharmacotherapy in patients with symptomatic atrial fibrillation as first-line management.2-4 Amiodarone is a very effective, and therefore, a commonly prescribed agent for this purpose.5 Anticoagulation is a key tenet in the management of atrial fibrillation due to the increased tendency of left atrial appendage clot formati...
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 10, 2023 Category: Anesthesiology Authors: Nicolas Kumar, Manoj H. Iyer, Adam Dalia, Amit Bardia Tags: Editorial Source Type: research

Predicting Postoperative Atrial Fibrillation: The Search Continues
Atrial fibrillation (AF) has an incredibly large burden on the American health system with approximately 454,000 annual hospital admissions as the primary diagnosis.1 Unfortunately, AF is not a benign entity, with a reported underlying primary cause of death in 26,535 people in 2019 according to the CDC.2 AF is the cause of 1 in 7 strokes,3 and increases the risk of ischemic stroke five-fold.4 These statistics are alarming when it is considered that the incidence of postoperative atrial fibrillation (POAF) has been reported to be as high as 65% after cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - June 12, 2022 Category: Anesthesiology Authors: Kenneth R. Hassler, Harish Ramakrishna Tags: Editorial Source Type: research

A wolf in sheep's skin? Postoperative atrial fibrillation after cardiac surgery and the risk of stroke and mortality
Postoperative Atrial Fibrillation (poAF; AF) is the most common complication after heart surgery.1 Up to 50% of patients who present preoperatively in normal sinus rhythm will develop poAF after cardiac surgery making it the most common postoperative morbidity.2 It is hypothesized that inflammation, increased sympathoadrenal activation, and oxidative stress unmask the propensity for developing poAF in at-risk patients, thereby leading to blood stasis and clot formation in the left atrium.3 Resulting thromboembolism and cerebrovascular accidents can dramatically change the postoperative course and affect patients ’ lives.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 19, 2021 Category: Anesthesiology Authors: Sergey Karamnov, Benjamin O'Brien, Jochen D. Muehlschlegel Source Type: research

Early Thromboembolic Stroke Risk of Postoperative Atrial Fibrillation Following Cardiac Surgery
We aimed to study the association between postoperative atrial fibrillation (POAF) and thromboembolic stroke and to determine risk factors for thromboembolic stroke following cardiac surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 20, 2021 Category: Anesthesiology Authors: Ramon Pierik, Miriam Zeillemaker-Hoekstra, Thomas W.L. Scheeren, Michiel E. Erasmus, Gert-Jan R. Luijckx, Michiel Rienstra, Maarten Uyttenboogaart, Maarten Nijsten, Walter M. van den Bergh Source Type: research

New-onset Atrial Fibrillation after Cardiac Surgery is a Significant Risk Factor for Long-term Stroke: An 8-Year Prospective Cohort Study
This study sought to determine the incidence and significance of new-onset atrial fibrillation as a risk factor for long-term stroke and mortality after cardiac surgery.Design: A prospective cohort study.Setting: 2 large tertiary public hospitalsParticipants: The study comprised 3008 patients who underwent coronary artery bypass grafting and/or valve surgery from 2008 to 2012.Interventions: None.Measurements and Main Results: new-onset atrial fibrillation was analysed as a risk factor for postoperative stroke using a multivariable logistic regression model following adjustment for potential confounders.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 8, 2021 Category: Anesthesiology Authors: Kevin K.P. Wang, Weiling Liu, Sophia T.H. Chew, Lian Kah Ti, Liang Shen Source Type: research

Analysis of the ESC/EACTS 2020 Atrial Fibrillation Guidelines with Perioperative Implications
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia worldwide with an individual lifetime risk of approximately 37% in the United States. Broadly defined as a supraventricular tachyarrhythmia with disorganized atrial activation, AF results in an increased risk of stroke, heart failure (HF), valvular heart disease (VHD), impaired quality of life and confers a significant burden to the health of individuals and society. AF in the perioperative setting is common and a significant source of perioperative morbidity and mortality worldwide.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 15, 2021 Category: Anesthesiology Authors: James A. Nelson, Ying X. Gue, Jon M. Christensen, Gregory Y.H. Lip, Harish Ramakrishna Tags: Expert Review Source Type: research

How to Manage the Perioperative Patient on Combined Anticoagulant and Antiplatelet Therapy: Comments on the 2020 ACC Consensus Decision Pathway
Antithrombotic drugs are frequently used to prevent or treat various common cardiovascular disorders like acute coronary syndrome (ACS), stroke, atrial fibrillation (AF), and venous thromboembolism (VTE). Mainly, two classes of oral antithrombotic drugs are on market: anticoagulants, which slow down clot formation by reduced thrombin generation and fibrin formation; and antiplatelet drugs, which prevent platelet activation and formation of stable clots. Combined anticoagulant and antiplatelet therapy might be indicated in some patients, but it is associated with increased risk of critical bleeding.
Source: Journal of Cardiothoracic and Vascular Anesthesia - January 28, 2021 Category: Anesthesiology Authors: Daniel Bolliger, Jens Fassl, Gabor Erdoes Tags: Editorial Commentary Source Type: research

Andexanet Alfa Use in Cardiac Surgical Patients: A Xa Inhibitor and Heparin Reversal Agent
THE NONVITAMIN K direct oral anticoagulants (DOACs) currently are approved for clinical use for the prevention of cerebrovascular embolic stroke in patients with nonvalvular atrial fibrillation, and as antithrombotic therapy and prophylaxis.1 As a result, clinicians should be aware of perioperative management strategies for both elective and emergency surgery in patients receiving these agents. Currently, specific reversal agents, also referred to as antidotes, are available for dabigatran (idarucizumab) and Xa inhibitors (andexanet alfa).
Source: Journal of Cardiothoracic and Vascular Anesthesia - October 13, 2020 Category: Anesthesiology Authors: Jerrold H. Levy, Jean M. Connors Tags: Editorial Source Type: research

Left Atrial Myxoma Presenting as Cerebral Infarct
ACUTE embolic cerebral stroke is a major health setback for any individual, with increased mortality and morbidity. Embolus arising from cardiac chambers constitutes about 20% of ischemic strokes. Atrial fibrillation is the root cause of more than 50% of cardiogenic emboli, whereas congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic heart valves, rheumatic heart valvular disease, dilated cardiomyopathy, and endocarditis are predisposing factors for cardiogenic emboli.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 5, 2020 Category: Anesthesiology Authors: Hemant Digambar Waikar, Aylliath Gosalakkal Jayakrishnan, Bodiabaduge Senaka Nimalakeerthi Bandusena, Prakash Priyadarshan, Peter Parthepan Kamalaneson, Abhaya Ileperuma, Praveen Kumar Neema, Richa Dhawan, Mark A. Chaney Tags: Case Conference Source Type: research

Left Atrial Myxoma Presenting as Cerebral Embolism
ACUTE embolic cerebral stroke is a major health setback for any individual, with increased mortality and morbidity. Embolus arising from cardiac chambers constitutes about 20% of ischemic strokes. Atrial fibrillation is the root cause of more than 50% of cardiogenic emboli, whereas congenital heart diseases, such as atrial septal defect, patent foramen ovale, prosthetic heart valves, rheumatic heart valvular disease, dilated cardiomyopathy, and endocarditis are predisposing factors for cardiogenic emboli.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 5, 2020 Category: Anesthesiology Authors: Hemant Digambar Waikar, Aylliath Gosalakkal Jayakrishnan, Bodiabaduge Senaka Nimalakeerthi Bandusena, Prakash Priyadarshan, Peter Parthepan Kamalaneson, Abhaya Ileperuma, Praveen Kumar Neema, Richa Dhawan, Mark A. Chaney Tags: Case Conference Source Type: research

Doing Simple Things Well: Practice Advisory Implementation Reduces Atrial Fibrillation After Cardiac Surgery
Atrial Fibrillation After Cardiac Surgery (AFACS) is associated with increased morbidity, including thromboembolic stroke, renal failure, gastrointestinal complications, infections, and prolonged ventilation, and a significant increase in the risk of subsequent chronic atrial fibrillation.1-4 Furthermore, it is associated with an increase in mortality and hospital and intensive care unit length of stay.1,3 It has a persistently high incidence, ranging from 30% to more than 50%, depending on the type of surgery.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 29, 2020 Category: Anesthesiology Authors: Martina Buerge, Rosalie Magboo, Dylan Wills, Ioannis Karpouzis, Damian Balmforth, Paul Cooper, Neil Roberts, Ben O'Brien Tags: Special Article Source Type: research

Device-Detected Subclinical Atrial Fibrillation: The Anesthesiologist's Perspective
A RECENT American Heart Association article published in Circulation in December 2019 discussed subclinical atrial fibrillation (SCAF). SCAF, per Noseworthy et al., is defined as asymptomatic atrial fibrillation (AF) episodes captured by various cardiac devices and confirmed by electrocardiogram (ECG) analysis. As more of these devices, including implantable cardiac, wearable, or intracardiac monitors, are implemented, the incidence of SCAF has and will continue to increase. SCAF presents a cardiologist with multiple quandaries, including the initiation of stroke prophylaxis, and if so, how to proceed.
Source: Journal of Cardiothoracic and Vascular Anesthesia - July 16, 2020 Category: Anesthesiology Authors: Samit Ghia, Davendra Mehta, Himani V. Bhatt Tags: Editorial Source Type: research

Research Needs and Priorities for Catheter Ablation of Atrial Fibrillation
ATRIAL FIBRILLATION (AF) is the most common chronic arrhythmia encountered by physicians. According to the Framingham Heart Study, the lifetime risk of AF at age 80 is 22.7% in men and 21.7% in women.1 Silent AF occurs in about 30% of patients, and, unfortunately, the first clinical manifestation can be a stroke.2 Thus, early diagnosis and management with anticoagulation are imperative. AF may be paroxysmal, usually lasting for minutes to hours before spontaneously converting back to sinus rhythm.
Source: Journal of Cardiothoracic and Vascular Anesthesia - May 13, 2020 Category: Anesthesiology Authors: Roger L. Royster, Rohesh J. Fernando, Elijah H. Beaty Tags: Editorial Source Type: research

CHA2DS2-VASc Score and In-Hospital Mortality in Critically Ill Patients With New-Onset Atrial Fibrillation
To examine the role of the CHA2DS2-VASc (Congestive heart failure; Hypertension; Age ≥75 years [doubled]; Diabetes; previous Stroke, transient ischemic attack, or thromboembolism [doubled]; Vascular disease; Age 65-75 years; and Sex category) score as a prognostic marker of in-hospital mortality in critically ill patients who develop new-onset atrial fibrillation (NOAF).
Source: Journal of Cardiothoracic and Vascular Anesthesia - December 29, 2019 Category: Anesthesiology Authors: Kunal Karamchandani, Robert S. Schoaps, Thomas Abendroth, Zyad J. Carr, Tonya S. King, Anthony Bonavia Tags: Original Article Source Type: research

The Effect of Steroids in Patients Undergoing Cardiopulmonary Bypass: An Individual Patient Meta-Analysis of Two Randomized Trials
Steroids suppress the inflammatory response to cardiopulmonary bypass, but the impact on death at 30 days, myocardial infarction or injury, stroke, renal failure, respiratory failure, new atrial fibrillation, transfusion requirement, infection, and length of intensive care unit (ICU) and hospital stays are uncertain.
Source: Journal of Cardiothoracic and Vascular Anesthesia - August 6, 2019 Category: Anesthesiology Authors: Richard P. Whitlock, Jan M. Dieleman, Emilie Belley-Cote, Jessica Vincent, Michelle Zhang, P.J. Devereaux, Cor J. Kalkman, Diederik van Dijk, Salim Yusuf Tags: Original Article Source Type: research

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