CONCLUSION
Different studies have showed the safety of NOACs as alternative to
warfarin in the treatment of AF and deep venous
thrombosis1-3. The updated guidelines on the
management of atrial fibrillation now recommends the new oral
anticoagulants (NOACs) as the preferred anticoagulant to warfarin,
unless patients have moderate to severe mitral stenosis or they have an
artificial heart valve4. Their use after cardiac
surgery seems to be safe as showed by a retrospective study that
evaluated the length of stay, the post-operative bleeding and the cost
of the therapy5.
This retrospective study evaluates the incidence of post-operative
pericardial effusion as a measure of bleeding event. No statistical
differences were observed in the two cohorts examined, with an incidence
similar between NOACs and Warfarin; despite the pre-operative use of
NOACs seems to increase the incidence of early re-exploration, this was
not statistically significant. A strong association was instead noted
between pericardial effusion and type of surgery. More interestingly, it
was observed that a high value of INR correlated with the effusion
drained; plus, almost all the patients re-admitted and on Warfarin,
required a surgical re-exploration.
In term of re-admission, after initial discharge, this was similar
between NOACs and warfarin, with no significant differences.
At the end, from this retrospective study, appears that the use of NOACs
in post cardiac surgery, appeared to be a safe and valid alternative to
warfarin, in term of incidence of pericardial effusion and need of
surgical drainage.
In patients undergoing surgery for valvular disease, expect in those
with mechanical valve, the use of NOACs appears safe as immediate
treatment.
This study has some limits: the overall cohort is small with a prevalent
warfarin group; second, the incidence of thromboembolic events and/or
other hemorrhagic events, was not considered as primary outcome.
Despite this, at follow-up, none of the patients in the study showed
significant complications, redo-surgery for graft or valve failure
and/or mortality.