Effectiveness of Anti-Inflammatory Agents to Prevent Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis

Preventing postoperative atrial fibrillation (POAF) as one of the most significant complications of cardiovascular surgeries remains a major clinical challenge. We conducted a systematic review with network meta-analysis of randomized controlled trials, to identify the most effective and safe anti-inflammatory drugs to prevent new-onset POAF. MEDLINE, Embase, Web of Science, and Cochrane Library were searched without language or publication-date restriction on August 8, 2022 (updated on August 8, 2023). We assessed the risk of bias of included trials using the Cochrane risk-of-bias 2.0 tool. We conducted a frequentist random-effects network meta-analysis in R, and we assessed the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. A total of 85 trials reported the incidence of new-onset POAF, including 18,981 patients. Use of nonsteroidal anti-inflammatory drugs (relative risk [RR] 0.37 [95% confidence interval [CI] 0.23-0.59]) and statins (RR 0.56 [95% CI 0.45-0.7]) potentially reduced the risk of POAF compared with placebo (both with a moderate certainty level). Use of fish oil in combination with vitamins C and E (RR 0.30 [95% CI 0.13-0.68]) may reduce the risk of POAF, compared with placebo (low level of certainty). Use of colchicine (RR 0.62 [95% CI 0.45- 0.85]), corticosteroids (RR 0.70 [95% CI 0.59-0.82]), and N-acetylcysteine (RR 0.69 [95% CI 0.49- 0.98]) may reduce the risk of POAF (all with a low level of certainty). None of the interventions had a significant effect on mortality rate or risk of serious adverse effects. Use of nonsteroidal anti-inflammatory drugs and statins probably are effective in preventing new-onset POAF, with a moderate level of certainty, compared to placebo. La prévention de la fibrillation auriculaire postopératoire (FAPO), l'une des complications les plus importantes des chirurgies cardiovasculaires, reste un défi clinique majeur. Nous avons effectué une revue systématique avec une méta-analyse en réseau des essais contrôlés randomisés, afin d'identifier les médicaments anti-inflammatoires les plus efficaces et les plus sûrs pour prévenir l'apparition de nouvelle FAPO. Nous avons effectué des recherches dans MEDLINE, Embase, Web of Science et Cochrane Library, sans restriction de langue ou de date de publication, le 8 août 2022 (mise à jour le 8 août 2023). Nous avons évalué le risque de biais des essais cliniques sélectionnés à l'aide de l'outil Cochran