Anticoagulation not useful in secondary AF? – New study

Anticoagulation in atrial fibrillation (AF) secondary to acute coronary syndrome, acute pulmonary disease or sepsis may not prevent stroke, but may increase risk of bleeding, says an new study published in JACC Clinical Electrophysiology [1]. The authors retrospectively evaluated a cohort of over 2300 patients aged 65 years or more who were hospitalized with acute coronary syndrome, acute pulmonary disease which included worsening of chronic obstructive pulmonary disease, pneumonia, influenza, pulmonary embolism and pleural effusion or sepsis associated with new onset AF during admission. Over a three year follow up, they could not find a lower incidence of ischemic stroke in those who were given anticoagulation. On the contrary, it was associated with a higher bleeding risk. Authors recommend careful individual assessment regarding the decision for anticoagulation in this setting.

Secondary AF has been defined as self limited arrhythmia caused by a reversible etiology. Conditions which cause secondary AF are myocardial infarction, myocarditis, pericarditis, acute pulmonary disease, hyperthyroidism, ethanol intoxication, sepsis and post operative state. It is well known that post operative AF can increase the morbidity and ICU /hospital stay after cardiac and non cardiac surgery.

Reference

  1. Quon MJ et al. Anticoagulant Use and Risk of Ischemic Stroke and Bleeding in Patients With Secondary Atrial Fibrillation Associated With Acute Coronary Syndromes, Acute Pulmonary Disease, or Sepsis. JACC: Clinical Electrophysiology. September 2017. DOI: 10.1016/j.jacep.2017.08.003