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.