Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery
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 t...
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| creator | Azimaraghi, Omid Rudolph, Maíra I. Wongtangman, Karuna Borngaesser, Felix Doehne, Maya Ng, Pauline Y. von Wedel, Dario Eyth, Annika Zou, Fengwei Tam, Christopher Sauer, William J. Kiyatkin, Michael E. Houle, Timothy T. Karaye, Ibraheem M. Zhang, Ling Schaefer, Maximilian S. Schaefer, Simon T. Himes, Carina P. Grimm, Aline M. Nafiu, Olubukola O. Mpody, Christian Suleiman, Aiman Stiles, Brendon M. Di Biase, Luigi Garcia, Mario J. Bhatt, Deepak L. Eikermann, Matthias |
| description | 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
|
| doi_str_mv | 10.1038/s41591-024-03206-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_3096666202</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>3096666202</sourcerecordid><originalsourceid>FETCH-LOGICAL-c256t-e45782cb7a3a3409d895d3691f05d2897b95b692c75ae9bbbdfbf74a3f0273783</originalsourceid><addsrcrecordid>eNp9kc2LVSEYhyWKZubWP9AihDZtrNev43EZQx8DA0EUtBM9R-84c67e1MNwd_3pWfdW0CIXKvj4e199EHpG4RUFPr6ugkpNCTBBgDMYCDxA51SKgVAFXx_2PaiRjFoOZ-ii1lsA4CD1Y3TGNVV6lOIcff-UF49zwDa1OGW7XRfbYk643fhi9wccE97lOYZDTFtcW8l3HpdY77CtNU_RNj_j-9hucPL3JKfqG7atRLvgEF2JyynOhuYLTjmRyZY52gnXtWx9OTxBj4Jdqn96Wjfoy7u3ny8_kOuP768u31yTicmhES-kGtnklOWWC9Bzf9bMB00DyJmNWjkt3aDZpKT12jk3BxeUsDwAU1yNfINeHnP3JX9bfW1mF-vke3_J57UaDnrogwHr6It_0Nu8ltS7M5yyUQxMCN4pdqSmkmstPph9iTtbDoaC-enHHP2Y7sf88tPnDXp-il7dzs9_rvwW0gF-BGo_Sv2D_tb-T-wPpDSdTA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>3128462443</pqid></control><display><type>article</type><title>Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery</title><source>Springer Nature - Complete Springer Journals</source><source>Nature Journals Online</source><creator>Azimaraghi, Omid ; Rudolph, Maíra I. ; Wongtangman, Karuna ; Borngaesser, Felix ; Doehne, Maya ; Ng, Pauline Y. ; von Wedel, Dario ; Eyth, Annika ; Zou, Fengwei ; Tam, Christopher ; Sauer, William J. ; Kiyatkin, Michael E. ; Houle, Timothy T. ; Karaye, Ibraheem M. ; Zhang, Ling ; Schaefer, Maximilian S. ; Schaefer, Simon T. ; Himes, Carina P. ; Grimm, Aline M. ; Nafiu, Olubukola O. ; Mpody, Christian ; Suleiman, Aiman ; Stiles, Brendon M. ; Di Biase, Luigi ; Garcia, Mario J. ; Bhatt, Deepak L. ; Eikermann, Matthias</creator><creatorcontrib>Azimaraghi, Omid ; Rudolph, Maíra I. ; Wongtangman, Karuna ; Borngaesser, Felix ; Doehne, Maya ; Ng, Pauline Y. ; von Wedel, Dario ; Eyth, Annika ; Zou, Fengwei ; Tam, Christopher ; Sauer, William J. ; Kiyatkin, Michael E. ; Houle, Timothy T. ; Karaye, Ibraheem M. ; Zhang, Ling ; Schaefer, Maximilian S. ; Schaefer, Simon T. ; Himes, Carina P. ; Grimm, Aline M. ; Nafiu, Olubukola O. ; Mpody, Christian ; Suleiman, Aiman ; Stiles, Brendon M. ; Di Biase, Luigi ; Garcia, Mario J. ; Bhatt, Deepak L. ; Eikermann, Matthias ; Boston-NYC Afib after non-cardiac surgery collaborators Consortium ; The Boston-NYC Afib after non-cardiac surgery collaborators Consortium</creatorcontrib><description>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.
In a large cohort of patients who underwent non-cardiac surgery, postoperative prescription of oral anticoagulation medication decreased the risk of stroke in patients with postoperative atrial fibrillation (POAF), especially for patients deemed to be at high risk for POAF based on a newly developed risk score.</description><identifier>ISSN: 1078-8956</identifier><identifier>ISSN: 1546-170X</identifier><identifier>EISSN: 1546-170X</identifier><identifier>DOI: 10.1038/s41591-024-03206-0</identifier><identifier>PMID: 39179854</identifier><language>eng</language><publisher>New York: Nature Publishing Group US</publisher><subject>692/308/409 ; 692/617/375/534 ; Anticoagulants ; Biomedical and Life Sciences ; Biomedicine ; Cancer Research ; Cardiac arrhythmia ; Comorbidity ; Fibrillation ; Health risks ; Heart ; Infectious Diseases ; Ischemia ; Metabolic Diseases ; Molecular Medicine ; Neurosciences ; Risk ; Stroke ; Surgery ; Therapy</subject><ispartof>Nature medicine, 2024-11, Vol.30 (11), p.3310-3317</ispartof><rights>The Author(s), under exclusive licence to Springer Nature America, Inc. 2024. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. The Author(s), under exclusive licence to Springer Nature America, Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c256t-e45782cb7a3a3409d895d3691f05d2897b95b692c75ae9bbbdfbf74a3f0273783</cites><orcidid>0009-0009-6431-2525 ; 0000-0002-7893-0596 ; 0009-0009-1610-0907 ; 0000-0003-2307-0864 ; 0000-0002-1278-6245</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1038/s41591-024-03206-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1038/s41591-024-03206-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/39179854$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Azimaraghi, Omid</creatorcontrib><creatorcontrib>Rudolph, Maíra I.</creatorcontrib><creatorcontrib>Wongtangman, Karuna</creatorcontrib><creatorcontrib>Borngaesser, Felix</creatorcontrib><creatorcontrib>Doehne, Maya</creatorcontrib><creatorcontrib>Ng, Pauline Y.</creatorcontrib><creatorcontrib>von Wedel, Dario</creatorcontrib><creatorcontrib>Eyth, Annika</creatorcontrib><creatorcontrib>Zou, Fengwei</creatorcontrib><creatorcontrib>Tam, Christopher</creatorcontrib><creatorcontrib>Sauer, William J.</creatorcontrib><creatorcontrib>Kiyatkin, Michael E.</creatorcontrib><creatorcontrib>Houle, Timothy T.</creatorcontrib><creatorcontrib>Karaye, Ibraheem M.</creatorcontrib><creatorcontrib>Zhang, Ling</creatorcontrib><creatorcontrib>Schaefer, Maximilian S.</creatorcontrib><creatorcontrib>Schaefer, Simon T.</creatorcontrib><creatorcontrib>Himes, Carina P.</creatorcontrib><creatorcontrib>Grimm, Aline M.</creatorcontrib><creatorcontrib>Nafiu, Olubukola O.</creatorcontrib><creatorcontrib>Mpody, Christian</creatorcontrib><creatorcontrib>Suleiman, Aiman</creatorcontrib><creatorcontrib>Stiles, Brendon M.</creatorcontrib><creatorcontrib>Di Biase, Luigi</creatorcontrib><creatorcontrib>Garcia, Mario J.</creatorcontrib><creatorcontrib>Bhatt, Deepak L.</creatorcontrib><creatorcontrib>Eikermann, Matthias</creatorcontrib><creatorcontrib>Boston-NYC Afib after non-cardiac surgery collaborators Consortium</creatorcontrib><creatorcontrib>The Boston-NYC Afib after non-cardiac surgery collaborators Consortium</creatorcontrib><title>Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery</title><title>Nature medicine</title><addtitle>Nat Med</addtitle><addtitle>Nat Med</addtitle><description>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.
In a large cohort of patients who underwent non-cardiac surgery, postoperative prescription of oral anticoagulation medication decreased the risk of stroke in patients with postoperative atrial fibrillation (POAF), especially for patients deemed to be at high risk for POAF based on a newly developed risk score.</description><subject>692/308/409</subject><subject>692/617/375/534</subject><subject>Anticoagulants</subject><subject>Biomedical and Life Sciences</subject><subject>Biomedicine</subject><subject>Cancer Research</subject><subject>Cardiac arrhythmia</subject><subject>Comorbidity</subject><subject>Fibrillation</subject><subject>Health risks</subject><subject>Heart</subject><subject>Infectious Diseases</subject><subject>Ischemia</subject><subject>Metabolic Diseases</subject><subject>Molecular Medicine</subject><subject>Neurosciences</subject><subject>Risk</subject><subject>Stroke</subject><subject>Surgery</subject><subject>Therapy</subject><issn>1078-8956</issn><issn>1546-170X</issn><issn>1546-170X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNp9kc2LVSEYhyWKZubWP9AihDZtrNev43EZQx8DA0EUtBM9R-84c67e1MNwd_3pWfdW0CIXKvj4e199EHpG4RUFPr6ugkpNCTBBgDMYCDxA51SKgVAFXx_2PaiRjFoOZ-ii1lsA4CD1Y3TGNVV6lOIcff-UF49zwDa1OGW7XRfbYk643fhi9wccE97lOYZDTFtcW8l3HpdY77CtNU_RNj_j-9hucPL3JKfqG7atRLvgEF2JyynOhuYLTjmRyZY52gnXtWx9OTxBj4Jdqn96Wjfoy7u3ny8_kOuP768u31yTicmhES-kGtnklOWWC9Bzf9bMB00DyJmNWjkt3aDZpKT12jk3BxeUsDwAU1yNfINeHnP3JX9bfW1mF-vke3_J57UaDnrogwHr6It_0Nu8ltS7M5yyUQxMCN4pdqSmkmstPph9iTtbDoaC-enHHP2Y7sf88tPnDXp-il7dzs9_rvwW0gF-BGo_Sv2D_tb-T-wPpDSdTA</recordid><startdate>20241101</startdate><enddate>20241101</enddate><creator>Azimaraghi, Omid</creator><creator>Rudolph, Maíra 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Ng, Pauline Y. ; von Wedel, Dario ; Eyth, Annika ; Zou, Fengwei ; Tam, Christopher ; Sauer, William J. ; Kiyatkin, Michael E. ; Houle, Timothy T. ; Karaye, Ibraheem M. ; Zhang, Ling ; Schaefer, Maximilian S. ; Schaefer, Simon T. ; Himes, Carina P. ; Grimm, Aline M. ; Nafiu, Olubukola O. ; Mpody, Christian ; Suleiman, Aiman ; Stiles, Brendon M. ; Di Biase, Luigi ; Garcia, Mario J. ; Bhatt, Deepak L. ; Eikermann, Matthias</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-e45782cb7a3a3409d895d3691f05d2897b95b692c75ae9bbbdfbf74a3f0273783</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>692/308/409</topic><topic>692/617/375/534</topic><topic>Anticoagulants</topic><topic>Biomedical and Life Sciences</topic><topic>Biomedicine</topic><topic>Cancer Research</topic><topic>Cardiac arrhythmia</topic><topic>Comorbidity</topic><topic>Fibrillation</topic><topic>Health 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Boston-NYC Afib after non-cardiac surgery collaborators Consortium</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery</atitle><jtitle>Nature medicine</jtitle><stitle>Nat Med</stitle><addtitle>Nat Med</addtitle><date>2024-11-01</date><risdate>2024</risdate><volume>30</volume><issue>11</issue><spage>3310</spage><epage>3317</epage><pages>3310-3317</pages><issn>1078-8956</issn><issn>1546-170X</issn><eissn>1546-170X</eissn><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.
In a large cohort of patients who underwent non-cardiac surgery, postoperative prescription of oral anticoagulation medication decreased the risk of stroke in patients with postoperative atrial fibrillation (POAF), especially for patients deemed to be at high risk for POAF based on a newly developed risk score.</abstract><cop>New York</cop><pub>Nature Publishing Group US</pub><pmid>39179854</pmid><doi>10.1038/s41591-024-03206-0</doi><tpages>8</tpages><orcidid>https://orcid.org/0009-0009-6431-2525</orcidid><orcidid>https://orcid.org/0000-0002-7893-0596</orcidid><orcidid>https://orcid.org/0009-0009-1610-0907</orcidid><orcidid>https://orcid.org/0000-0003-2307-0864</orcidid><orcidid>https://orcid.org/0000-0002-1278-6245</orcidid></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1078-8956 |
| ispartof | Nature medicine, 2024-11, Vol.30 (11), p.3310-3317 |
| issn | 1078-8956 1546-170X 1546-170X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_3096666202 |
| source | Springer Nature - Complete Springer Journals; Nature Journals Online |
| subjects | 692/308/409 692/617/375/534 Anticoagulants Biomedical and Life Sciences Biomedicine Cancer Research Cardiac arrhythmia Comorbidity Fibrillation Health risks Heart Infectious Diseases Ischemia Metabolic Diseases Molecular Medicine Neurosciences Risk Stroke Surgery Therapy |
| title | Role of anticoagulation therapy in modifying stroke risk associated with new-onset atrial fibrillation after non-cardiac surgery |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-30T20%3A05%3A14IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Role%20of%20anticoagulation%20therapy%20in%20modifying%20stroke%20risk%20associated%20with%20new-onset%20atrial%20fibrillation%20after%20non-cardiac%20surgery&rft.jtitle=Nature%20medicine&rft.au=Azimaraghi,%20Omid&rft.aucorp=Boston-NYC%20Afib%20after%20non-cardiac%20surgery%20collaborators%20Consortium&rft.date=2024-11-01&rft.volume=30&rft.issue=11&rft.spage=3310&rft.epage=3317&rft.pages=3310-3317&rft.issn=1078-8956&rft.eissn=1546-170X&rft_id=info:doi/10.1038/s41591-024-03206-0&rft_dat=%3Cproquest_cross%3E3096666202%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=3128462443&rft_id=info:pmid/39179854&rfr_iscdi=true |