Abstract
Résumé
I. Management of Antithrombotic Therapy in Patients With Concomitant AF and CAD

- Lip G.Y.
- Windecker S.
- Huber K.
- et al.
- 1.We recommend that patients who have concomitant AF and CAD receive a regimen of antithrombotic therapy that is on the basis of a balanced assessment of their risks of stroke, of a coronary event, and of hemorrhage associated with use of antithrombotic agents (Strong Recommendation, High-Quality Evidence).
- 2.When OAC is indicated in the presence of CAD, we suggest a NOAC in preference to warfarin for NVAF (Conditional Recommendation, Low-Quality Evidence).
Concomitant AF and stable CAD
- 3.If the patient has no evidence of CAD/vascular disease and is aged < 65 years with no CHADS2 risk factors, we suggest no antithrombotic therapy for stroke prevention (Conditional Recommendation, Moderate-Quality Evidence).
- 4.If the patient has stable CAD/vascular disease and is aged < 65 years with no CHADS2 risk factors, we suggest ASA 81 mg/d (Conditional Recommendation, Moderate-Quality Evidence).
- 5.If the patient has stable CAD/vascular disease and is aged ≥ 65 years or the CHADS2 score ≥ 1, we recommend OAC therapy alone (Strong Recommendation, High-Quality Evidence).

Concomitant AF and Elective PCI
- 6.If the patient is aged < 65 years with no CHADS2 risk factors, we recommend an APT therapy regimen without OAC, as per Part 7, Recommendations 6-9 of the Supplementary Material (adapted from the CCS 2012 APT guidelines).
- 7.If the patient is aged ≥ 65 years and the CHADS2 score ≥ 1, we suggest that clopidogrel 75 mg/d and OAC be given, without concomitant ASA, for 12 months post-PCI (Conditional Recommendation, Moderate-Quality Evidence), to be followed by OAC alone (Strong Recommendation, High-Quality Evidence).

Concomitant AF and NSTEACS or STEMI
- Lip G.Y.
- Windecker S.
- Huber K.
- et al.
- 8.If the patient is aged < 65 years with no CHADS2 risk factors, we recommend an APT therapy regimen without OAC, as per Part 7, Recommendations 11-19 of the Supplementary Material (adapted from the CCS 2012 APT Guidelines).
- 9.If the patient is aged ≥ 65 or the CHADS2 score ≥ 1 and no PCI is undertaken, we suggest the combination of clopidogrel 75 mg daily (rather than prasugrel or ticagrelor) and OAC be given, without concomitant ASA, for 12 months, to be followed by OAC alone (Conditional Recommendation, Low-Quality Evidence).
- 10.If the patient is aged ≥ 65 years or the CHADS2 score ≥ 1 and PCI is undertaken, we suggest the combination of ASA 81 mg/d and clopidogrel 75 mg/d and OAC (TT) for 3-6 months (duration depending on the perceived risks of coronary thrombosis and major bleeding). After 3-6 months we suggest the combination of clopidogrel and OAC to be continued until 12 months after ACS, to be followed by OAC alone (Conditional Recommendation, Low-Quality Evidence).

II. Real Life Data With NOACs
U.S. Food and Drug Administration. FDA drug safety communication: safety review of post-market reports of serious bleeding events with the anticoagulant Pradaxa (dabigatran etexilate mesylate). Available at: http://www.fda.gov/Drugs/DrugSafety/ucm282724.htm. Accessed May 10, 2016.
III. Reversal Agents for NOACs
Thrombosis Canada. Tools. Bleed Management. Available at: http://thrombosiscanada.ca/?page_id=502&calc=vivomap271. Accessed May 10, 2016.
Glund S, Stangier J, Schmohl M, et al. Idarucizumab, a specific antidote for dabigatran: immediate, complete and sustained reversal of dabigatran induced anticoagulation in elderly and renally impaired subjects. Available at: https://ash.confex.com/ash/2014/webprogram/Paper74960.html. Accessed May 10, 2016.
- 11.We recommend administering idarucizumab for emergency reversal of dabigatran's anticoagulant effect in patients with uncontrollable or potentially life-threatening bleeding and/or in patients who require urgent surgery for which normal hemostasis is necessary (Strong Recommendation, Moderate-Quality Evidence).
IV. Periprocedural Anticoagulation Management
Interruption of antithrombotic therapy
Thrombosis Canada. Peri-operative management of patients who are receiving warfarin. Available at: http://www.thrombosiscanada.ca/guides/pdfs/Warfarin_perioperative_management.pdf. Accessed May 10, 2016.
- 12.We suggest that interruption of anticoagulant therapy, particularly for VKAs, in a patient with AF/AFL is not necessary for most procedures with a low risk of bleeding, such as cardiac device implantation (pacemaker or implantable defibrillator), and most dental procedures (Table 1) (Conditional Recommendation, Moderate-Quality Evidence).
High-risk |
Neurosurgery (intracranial or spinal surgery) |
Cardiac surgery (coronary artery bypass or heart valve replacement) |
Major vascular surgery (abdominal aortic aneurysm repair, aortofemoral bypass) |
Major urologic surgery (prostatectomy, bladder tumour resection) |
Major lower limb orthopaedic surgery (hip/knee joint replacement surgery) |
Lung resection surgery |
Intestinal anastomosis surgery |
Selected invasive procedures (kidney biopsy, prostate biopsy, cervical cone biopsy, pericardiocentesis, colonic polypectomy or biopsies) |
Intermediate risk |
Other intra-abdominal surgery |
Other intrathoracic surgery |
Other orthopaedic surgery |
Other vascular surgery |
Low risk |
Laparoscopic cholecystectomy |
Laparoscopic inguinal hernia repair |
Dental procedures |
Dermatologic procedures |
Ophthalmologic procedures |
Coronary angiography |
Gastroscopy or colonoscopy (without biopsy) |
Selected invasive procedures (bone marrow aspirate and biopsy, lymph node biopsy, thoracentesis, paracentesis, arthrocentesis) |
Cardiac implantable device surgery (pacemaker or implantable defibrillator) |
Dental extractions (1 or 2 teeth) or teeth cleaning |
Skin biopsy or skin cancer removal |
Cataract removal |
Bridging considerations
- 13.When a decision to interrupt warfarin therapy for an invasive procedure has been made for a patient with AF/AFL, we suggest that bridging therapy with LMWH or UFH be instituted when the INR is below therapeutic level only in patients at high risk of thromboembolic events (CHADS2, score ≥ 4, mechanical heart valve, stroke/transient ischemic attack within 3 months, rheumatic heart disease) (Conditional Recommendation, Low-Quality Evidence).
- Sherwood M.W.
- Douketis J.D.
- Patel M.R.
- et al.
- 14.We recommend no bridging (LMWH or UFH) for NVAF patients receiving NOACs who undergo elective surgery or invasive procedures requiring interruption of anticoagulation (Strong Recommendation, Moderate-Quality Evidence).
V. Digoxin and Mortality
- Washam J.B.
- Stevens S.R.
- Lokhnygina Y.
- et al.
- 15.We suggest that digoxin can be considered as a therapeutic option to achieve rate control in patients with AF and symptoms caused by rapid ventricular rates whose response to β-blockers and/or calcium channel blockers is inadequate, or in whom such rate-controlling drugs are contraindicated or not tolerated (Conditional Recommendation, Moderate-Quality Evidence).
VI. Surgical Therapy for AF
Surgical AF ablation procedures
- Budera P.
- Straka Z.
- Osmancik P.
- et al.
- Budera P.
- Straka Z.
- Osmancik P.
- et al.
- Budera P.
- Straka Z.
- Osmancik P.
- et al.
- 16.We suggest that a surgical AF ablation procedure should be considered in association with mitral valve, aortic valve, or CABG surgery in patients with AF, when the likelihood of success is deemed to be high, the additional risk is low and sinus rhythm is expected to achieve substantial symptomatic benefit (Conditional Recommendation, Moderate-Quality Evidence).
Surgical LAA exclusion for stroke prevention
- Budera P.
- Straka Z.
- Osmancik P.
- et al.
- 17.In patients with AF, we suggest that closure (excision or obliteration) of the LAA should be considered as part of the surgical ablation of AF associated with mitral, aortic valve, or CABG surgery if this does not increase the risk of the surgery (Conditional Recommendation, Low-Quality Evidence).
VII. Prevention and Treatment of AF After Cardiac Surgery
- 18.We recommend that POAF might be appropriately treated with either a ventricular response rate control strategy or a rhythm control strategy (Strong Recommendation, Moderate-Quality Evidence).
Magnesium and atrial pacing
Limiting inflammation and oxidative stress
- 19.We suggest that patients who have a contraindication to β-blocker therapy and to amiodarone before or after cardiac surgery be considered for prophylactic therapy to prevent POAF with intravenous magnesium (Conditional Recommendation, Low-Quality Evidence) or colchicine (Conditional Recommendation, Low-Quality Evidence) or with biatrial pacing (Conditional Recommendation, Low-Quality Evidence).
Acknowledgements
Supplementary Material
- Supplementary Material
References
- Canadian Cardiovascular Society atrial fibrillation guidelines 2010: implementing GRADE and achieving consensus.Can J Cardiol. 2011; 27: 27-30
- Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control.Can J Cardiol. 2012; 28: 125-136
- 2014 focused update of the Canadian Cardiovascular Society guidelines for the management of atrial fibrillation.Can J Cardiol. 2014; 30: 1114-1130
- Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention of stroke and systemic thromboembolism in atrial fibrillation and flutter.Can J Cardiol. 2011; 27: 74-90
- The 2014 atrial fibrillation guidelines companion: a practical approach to the use of the Canadian Cardiovascular Society guidelines.Can J Cardiol. 2015; 31: 1207-1218
- The use of antiplatelet therapy in the outpatient setting: Canadian Cardiovascular Society guidelines.Can J Cardiol. 2011; 27: S1-S59
- Focused 2012 update of the Canadian Cardiovascular Society guidelines for the use of antiplatelet therapy.Can J Cardiol. 2013; 29: 1334-1345
- The net clinical benefit of warfarin anticoagulation in atrial fibrillation.Ann Intern Med. 2009; 151: 297-305
- Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS).Eur Heart J. 2014; 35: 3155-3179
- Updated European Heart Rhythm Association practical guide on the use of non-vitamin K antagonist anticoagulants in patients with non-valvular atrial fibrillation.Europace. 2015; 17: 1467-1507
- Consensus document: antithrombotic therapy in patients with atrial fibrillation undergoing coronary stenting. A North American perspective.Thromb Haemost. 2011; 106: 572-584
- Oral antithrombotic therapy in atrial fibrillation associated with acute or chronic coronary artery disease.Can J Cardiol. 2013; 29: S60-S70
- Antithrombotic agents in coronary artery disease.Chest. 1998; 114: 611S-633S
- The effect of warfarin on mortality and reinfarction after myocardial infarction.N Engl J Med. 1990; 323: 147-152
- Warfarin, aspirin, or both after myocardial infarction.N Engl J Med. 2002; 347: 969-974
- Department of Veterans Affairs Cooperative Studies Program clinical trial comparing combined warfarin and aspirin with aspirin alone in survivors of acute myocardial infarction: primary results of the CHAMP study.Circulation. 2002; 105: 557-563
- Oral anticoagulants in patients with coronary artery disease.J Am Coll Cardiol. 2003; 41: 62S-69S
- Antithrombotic therapy for atrial fibrillation: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines.Chest. 2012; 141: e531S-e575
- Dabigatran versus warfarin in patients with atrial fibrillation.N Engl J Med. 2009; 361: 1139-1151
- Myocardial ischemic events in patients with atrial fibrillation treated with dabigatran or warfarin in the RE-LY (Randomized Evaluation of Long-Term Anticoagulation Therapy) trial.Circulation. 2012; 125: 669-676
- Coronary and mortality risk of novel oral antithrombotic agents: a meta-analysis of large randomised trials.BMJ Open. 2012; 2
- Efficacy and safety of the novel oral anticoagulants in atrial fibrillation: a systematic review and meta-analysis of the literature.Circulation. 2012; 126: 2381-2391
- Apixaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2011; 365: 981-992
- Rivaroxaban versus warfarin in nonvalvular atrial fibrillation.N Engl J Med. 2011; 365: 883-891
- Edoxaban versus warfarin in patients with atrial fibrillation.N Engl J Med. 2013; 369: 2093-2104
- Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.Lancet. 2014; 383: 955-962
- Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents.N Engl J Med. 2014; 371: 2155-2166
- Optimal duration of dual antiplatelet therapy after percutaneous coronary intervention with drug eluting stents: meta-analysis of randomised controlled trials.BMJ. 2015; 350: h1618
- Mortality in patients treated with extended duration dual antiplatelet therapy after drug-eluting stent implantation: a pairwise and Bayesian network meta-analysis of randomised trials.Lancet. 2015; 385: 2371-2382
- Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis.BMJ. 2014; 349: g6427
- Zotarolimus-eluting versus bare-metal stents in uncertain drug-eluting stent candidates.J Am Coll Cardiol. 2015; 65: 805-815
- Benefits and risks of extended duration dual antiplatelet therapy after PCI in patients with and without acute myocardial infarction.J Am Coll Cardiol. 2015; 65: 2211-2221
- Use and outcomes of triple therapy among older patients with acute myocardial infarction and atrial fibrillation.J Am Coll Cardiol. 2015; 66: 616-627
- Meta-analysis of randomized controlled trials and adjusted observational results of use of clopidogrel, aspirin, and oral anticoagulants in patients undergoing percutaneous coronary intervention.Am J Cardiol. 2015; 115: 1185-1193
- Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial.Lancet. 2013; 381: 1107-1115
- Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study.Lancet. 2001; 358: 527-533
- Prasugrel versus clopidogrel in patients with acute coronary syndromes.N Engl J Med. 2007; 357: 2001-2015
- Ticagrelor versus clopidogrel in patients with acute coronary syndromes.N Engl J Med. 2009; 361: 1045-1057
- Long-term use of ticagrelor in patients with prior myocardial infarction.N Engl J Med. 2015; 372: 1791-1800
- Effect of clopidogrel added to aspirin in patients with atrial fibrillation.N Engl J Med. 2009; 360: 2066-2078
- Concomitant use of antiplatelet therapy with dabigatran or warfarin in the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) trial.Circulation. 2013; 127: 634-640
- Duration of triple therapy in patients requiring oral anticoagulation after drug-eluting stent implantation: the ISAR-TRIPLE trial.J Am Coll Cardiol. 2015; 65: 1619-1629
- Rivaroxaban in patients with a recent acute coronary syndrome.N Engl J Med. 2012; 366: 9-19
- Cardiovascular, bleeding, and mortality risks in elderly Medicare patients treated with dabigatran or warfarin for nonvalvular atrial fibrillation.Circulation. 2015; 131: 157-164
U.S. Food and Drug Administration. FDA drug safety communication: safety review of post-market reports of serious bleeding events with the anticoagulant Pradaxa (dabigatran etexilate mesylate). Available at: http://www.fda.gov/Drugs/DrugSafety/ucm282724.htm. Accessed May 10, 2016.
- Dabigatran use in elderly patients with atrial fibrillation.Thromb Haemost. 2016; 115: 152-160
- Effectiveness and safety of dabigatran and warfarin in real-world US patients with non-valvular atrial fibrillation: a retrospective cohort study.J Am Heart Assoc. 2015; 4
- Characterizing major bleeding in patients with nonvalvular atrial fibrillation: a pharmacovigilance study of 27 467 patients taking rivaroxaban.Clin Cardiol. 2015; 38: 63-68
- Real-world comparative effectiveness and safety of rivaroxaban and warfarin in nonvalvular atrial fibrillation patients.Curr Med Res Opin. 2014; 30: 1317-1325
- Sex differences in dabigatran use, safety, and effectiveness in a population-based cohort of patients with atrial fibrillation.Circ Cardiovasc Qual Outcomes. 2015; 8: 593-599
- Poor prognosis in warfarin-associated intracranial hemorrhage despite anticoagulation reversal.Stroke. 2012; 43: 1812-1817
- Predictors of outcome in warfarin-related intracerebral hemorrhage.Arch Neurol. 2008; 65: 1320-1325
- European Heart Rhythm Association practical guide on the use of new oral anticoagulants in patients with non-valvular atrial fibrillation.Europace. 2013; 15: 625-651
Thrombosis Canada. Tools. Bleed Management. Available at: http://thrombosiscanada.ca/?page_id=502&calc=vivomap271. Accessed May 10, 2016.
- Who, when, and how to reverse non-vitamin K oral anticoagulants.J Thromb Thrombolysis. 2016; 41: 253-272
- Reversal of oral factor Xa inhibitors by prothrombin complex concentrates: a re-appraisal.J Thromb Haemost. 2015; 13: S187-S194
- Safety of prothrombin complex concentrates for rapid anticoagulation reversal of vitamin K antagonists. a meta-analysis.Thromb Haemost. 2011; 106: 429-438
- Bleeding complications from the direct oral anticoagulants.BMC Hematol. 2015; 15: 18
- Andexanet Alfa for the reversal of factor Xa inhibitor activity.N Engl J Med. 2015; 373: 2413-2424
- Idarucizumab: the antidote for reversal of dabigatran.Circulation. 2015; 132: 2412-2422
Glund S, Stangier J, Schmohl M, et al. Idarucizumab, a specific antidote for dabigatran: immediate, complete and sustained reversal of dabigatran induced anticoagulation in elderly and renally impaired subjects. Available at: https://ash.confex.com/ash/2014/webprogram/Paper74960.html. Accessed May 10, 2016.
- A randomised study in healthy volunteers to investigate the safety, tolerability and pharmacokinetics of idarucizumab, a specific antidote to dabigatran.Thromb Haemost. 2015; 113: 943-951
- Safety, tolerability, and efficacy of idarucizumab for the reversal of the anticoagulant effect of dabigatran in healthy male volunteers: a randomised, placebo-controlled, double-blind phase 1 trial.Lancet. 2015; 386: 680-690
- Idarucizumab for dabigatran reversal.N Engl J Med. 2015; 373: 511-520
- Dabigatran etexilate–a novel, reversible, oral direct thrombin inhibitor: interpretation of coagulation assays and reversal of anticoagulant activity.Thromb Haemost. 2010; 103: 1116-1127
- Management of anticoagulation before and after elective surgery.N Engl J Med. 1997; 336: 1506-1511
- Perioperative management of antithrombotic therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines.Chest. 2012; 141: e326S-e350
Thrombosis Canada. Peri-operative management of patients who are receiving warfarin. Available at: http://www.thrombosiscanada.ca/guides/pdfs/Warfarin_perioperative_management.pdf. Accessed May 10, 2016.
- Pacemaker or defibrillator surgery without interruption of anticoagulation.N Engl J Med. 2013; 368: 2084-2093
- Strategy of continued vs interrupted novel oral anticoagulant at time of device surgery in patients with moderate to high risk of arterial thromboembolic events: the BRUISE CONTROL-2 trial.Am Heart J. 2016; 173: 102-107
- Periprocedural heparin bridging in patients receiving vitamin K antagonists: systematic review and meta-analysis of bleeding and thromboembolic rates.Circulation. 2012; 126: 1630-1639
- Perioperative bridging anticoagulation in patients with atrial fibrillation.N Engl J Med. 2015; 373: 823-833
- Periprocedural bleeding and thromboembolic events with dabigatran compared with warfarin: results from the Randomized Evaluation of Long-Term Anticoagulation Therapy (RE-LY) randomized trial.Circulation. 2012; 126: 343-348
- Outcomes of temporary interruption of rivaroxaban compared with warfarin in patients with nonvalvular atrial fibrillation: results from the rivaroxaban once daily, oral, direct factor Xa inhibition compared with vitamin K antagonism for prevention of stroke and embolism trial in atrial fibrillation (ROCKET AF).Circulation. 2014; 129: 1850-1859
- Management and clinical outcomes in patients treated with apixaban vs warfarin undergoing procedures.Blood. 2014; 124: 3692-3698
- Interruption of all anticoagulation is non-inferior to the use of short-term parenteral bridging in patients with atrial fibrillation undergoing invasive procedures.Evid Based Med. 2015; 20: 200
- Perioperative management of dabigatran: a prospective cohort study.Circulation. 2015; 132: 167-173
- Peri-interventional management of novel oral anticoagulants in daily care: results from the prospective Dresden NOAC registry.Eur Heart J. 2014; 35: 1888-1896
- Ventricular rate control in chronic atrial fibrillation during daily activity and programmed exercise: a crossover open-label study of five drug regimens.J Am Coll Cardiol. 1999; 33: 304-310
- Inefficacy of digitalis in the control of heart rate in patients with chronic atrial fibrillation: beneficial effect of an added beta adrenergic blocking agent.Am J Cardiol. 1979; 44: 1378-1382
- Increased mortality associated with digoxin in contemporary patients with atrial fibrillation: findings from the TREAT-AF study.J Am Coll Cardiol. 2014; 64: 660-668
- Digoxin use in patients with atrial fibrillation and adverse cardiovascular outcomes: a retrospective analysis of the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonism for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET AF).Lancet. 2015; 385: 2363-2370
- Relation of digoxin use in atrial fibrillation and the risk of all-cause mortality in patients ≥65 years of age with versus without heart failure.Am J Cardiol. 2014; 114: 401-406
- Heart rate and adverse outcomes in patients with atrial fibrillation: a combined AFFIRM and AF-CHF substudy.Heart Rhythm. 2016; 13: 54-61
- Canadian Cardiovascular Society atrial fibrillation guidelines 2010: rate and rhythm management.Can J Cardiol. 2011; 27: 47-59
- Surgical ablation for treatment of atrial fibrillation in cardiac surgery: a cumulative meta-analysis of randomised controlled trials.Heart. 2014; 100: 722-730
- Comparison of cardiac surgery with left atrial surgical ablation vs. cardiac surgery without atrial ablation in patients with coronary and/or valvular heart disease plus atrial fibrillation: final results of the PRAGUE-12 randomized multicentre study.Eur Heart J. 2012; 33: 2644-2652
- Surgical ablation of atrial fibrillation during mitral-valve surgery.N Engl J Med. 2015; 372: 1399-1409
- Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease.J Thorac Cardiovasc Surg. 2002; 124: 575-583
- Early and late stroke after mitral valve replacement with a mechanical prosthesis: risk factor analysis of a 24-year experience.J Thorac Cardiovasc Surg. 2003; 126: 358-364
- The impact of mitral valve surgery combined with maze procedure.Eur J Cardiothorac Surg. 2006; 29: 1030-1035
- Impact of the maze procedure on the stroke rate in patients with atrial fibrillation.J Thorac Cardiovasc Surg. 1999; 118: 833-840
- Appendage obliteration to reduce stroke in cardiac surgical patients with atrial fibrillation.Ann Thorac Surg. 1996; 61: 755-759
- Percutaneous closure of the left atrial appendage versus warfarin therapy for prevention of stroke in patients with atrial fibrillation: a randomised non-inferiority trial.Lancet. 2009; 374: 534-542
- Prospective randomized evaluation of the Watchman Left Atrial Appendage Closure device in patients with atrial fibrillation versus long-term warfarin therapy: the PREVAIL trial.J Am Coll Cardiol. 2014; 64: 1-12
- Left Atrial Appendage Closure as an alternative to warfarin for stroke prevention in atrial fibrillation: a patient-level meta-analysis.J Am Coll Cardiol. 2015; 65: 2614-2623
- Left Atrial Appendage Occlusion Study II (LAAOS II).Can J Cardiol. 2013; 29: 1443-1447
- Rationale and design of the Left Atrial Appendage Occlusion Study (LAAOS) III.Ann Cardiothorac Surg. 2014; 3: 45-54
- Canadian Cardiovascular Society atrial fibrillation guidelines 2010: surgical therapy.Can J Cardiol. 2011; 27: 67-73
- Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery.Can J Cardiol. 2011; 27: 91-97
- Rate control versus rhythm control for atrial fibrillation after cardiac surgery.N Engl J Med. 2016; 374: 1911-1921
- Interventions for preventing post-operative atrial fibrillation in patients undergoing heart surgery.Cochrane Database Syst Rev. 2013; 1: CD003611
- Perioperative rosuvastatin in cardiac surgery.N Engl J Med. 2016; 374: 1744-1753
- Clinical benefit of steroid use in patients undergoing cardiopulmonary bypass: a meta-analysis of randomized trials.Eur Heart J. 2008; 29: 2592-2600
- Intraoperative high-dose dexamethasone for cardiac surgery: a randomized controlled trial.JAMA. 2012; 308: 1761-1767
- Methylprednisolone in patients undergoing cardiopulmonary bypass (SIRS): a randomised, double-blind, placebo-controlled trial.Lancet. 2015; 386: 1243-1253
- Polyunsaturated fatty acids for the prevention of atrial fibrillation after cardiac surgery: an updated meta-analysis of randomized controlled trials.J Cardiol. 2014; 63: 53-59
- Prevention of postoperative atrial fibrillation in open heart surgery patients by preoperative supplementation of n-3 polyunsaturated fatty acids: an updated meta-analysis.J Thorac Cardiovasc Surg. 2013; 146: 906-911
- Fish oil and postoperative atrial fibrillation: the Omega-3 Fatty Acids for Prevention of Post-operative Atrial Fibrillation (OPERA) randomized trial.JAMA. 2012; 308: 2001-2011
- Colchicine in prevention of atrial fibrillation following cardiac surgery: systematic review and meta-analysis.Indian J Pharmacol. 2014; 46: 590-595
- Colchicine in cardiac disease: a systematic review and meta-analysis of randomized controlled trials.BMC Cardiovasc Disord. 2015; 15: 96
Article Info
Publication History
Footnotes
The disclosure information of the authors and reviewers is available from the CCS on their guidelines library at www.ccs.ca.
This statement was developed following a thorough consideration of medical literature and the best available evidence and clinical experience. It represents the consensus of a Canadian panel comprised of multidisciplinary experts on this topic with a mandate to formulate disease-specific recommendations. These recommendations are aimed to provide a reasonable and practical approach to care for specialists and allied health professionals obliged with the duty of bestowing optimal care to patients and families, and can be subject to change as scientific knowledge and technology advance and as practice patterns evolve. The statement is not intended to be a substitute for physicians using their individual judgement in managing clinical care in consultation with the patient, with appropriate regard to all the individual circumstances of the patient, diagnostic and treatment options available and available resources. Adherence to these recommendations will not necessarily produce successful outcomes in every case.