دورية أكاديمية
Anticoagulation use in perioperative atrial fibrillation after noncardiac surgery: a systematic review and meta-analysis.
| العنوان: | Anticoagulation use in perioperative atrial fibrillation after noncardiac surgery: a systematic review and meta-analysis. |
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| المؤلفون: | Ke Wang M; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton (ON), Canada., Heo R; Michael G. DeGroote School of Medicine, McMaster University, Hamilton (ON), Canada., Meyre PB; Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland., Blum S; Population Health Research Institute, McMaster University, Hamilton (ON), Canada.; Division of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel, Basel, Switzerland., Park L; Faculty of Health Sciences, McMaster University, Hamilton (ON), Canada., Birchenough L; Faculty of Health Sciences, McMaster University, Hamilton (ON), Canada., Vuong K; Faculty of Sciences, Western University, London (ON), Canada., McIntyre WF; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton (ON), Canada., Healey JS; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton (ON), Canada., Devereaux PJ; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada.; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton (ON), Canada., McMullen M; Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston (ON), Canada., Mrkobrada M; Department of Medicine, Western University, London (ON), Canada., Pinilla-Echeverri N; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada., Styles K; Department of Medicine, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax (NS), Canada., Conen D; Department of Medicine, McMaster University, Hamilton (ON), Canada.; Population Health Research Institute, McMaster University, Hamilton (ON), Canada. |
| المصدر: | Swiss medical weekly [Swiss Med Wkly] 2023 Apr 18; Vol. 153, pp. 40056. Date of Electronic Publication: 2023 Apr 18. |
| نوع المنشور: | Meta-Analysis; Systematic Review; Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Trägerverein Swiss Medical Weekly SMW Country of Publication: Switzerland NLM ID: 100970884 Publication Model: Electronic Cited Medium: Internet ISSN: 1424-3997 (Electronic) Linking ISSN: 00367672 NLM ISO Abbreviation: Swiss Med Wkly Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2022- : Basel, Switzerland : Trägerverein Swiss Medical Weekly SMW Original Publication: Basel : EMH Swiss Medical Publishers Ltd., c2001- |
| مواضيع طبية MeSH: | Atrial Fibrillation*/drug therapy , Atrial Fibrillation*/complications , Stroke*/etiology , Stroke*/prevention & control , Stroke*/drug therapy , Myocardial Infarction*/epidemiology , Myocardial Infarction*/etiology , Myocardial Infarction*/prevention & control, Humans ; Anticoagulants/therapeutic use ; Hemorrhage/drug therapy |
| مستخلص: | Background: Perioperative atrial fibrillation is associated with an increased risk of stroke, myocardial infarction, and death after noncardiac surgery. Anticoagulation therapy is effective for stroke prevention in nonsurgical atrial fibrillation, but its efficacy and safety in perioperative atrial fibrillation are unknown. Methods: We searched MEDLINE, EMBASE, and CENTRAL from database inception until January 2022. We included studies comparing anticoagulation versus no anticoagulation use in patients with perioperative atrial fibrillation after noncardiac surgery. Our study outcomes included stroke ± systemic embolism, bleeding, mortality, myocardial infarction, and venous thromboembolism. We pooled studies using fixed-effects models. We reported summary risk ratios (RRs) for studies reporting multivariable-adjusted results. Results: Seven observational studies but no randomised trials were included. Of the 27,822 patients, 29.1% were prescribed therapeutic anticoagulation. Anticoagulation use was associated with a lower risk of stroke ± systemic embolism (RR 0.73; 95% CI, 0.62-0.85; I2 = 81%; 3 studies) but a higher risk of bleeding (RR 1.14; 95% CI, 1.04-1.25; 1 study). There was a lower risk of mortality associated with anticoagulation use (RR 0.45; 95% CI, 0.40-0.51; I2 = 80%; 2 studies). There was no difference in the risk of myocardial infarction (RR 2.19; 95% CI, 0.97-4.96; 1 study). The certainty of the evidence was very low across all outcomes. Conclusion: Anticoagulation is associated with a reduced risk of stroke and death but an increased risk of bleeding. The quality of the evidence is very poor. Randomised trials are needed to better determine the effects of anticoagulation use in this population. |
| المشرفين على المادة: | 0 (Anticoagulants) |
| تواريخ الأحداث: | Date Created: 20230420 Date Completed: 20230424 Latest Revision: 20230425 |
| رمز التحديث: | 20240628 |
| DOI: | 10.57187/smw.2023.40056 |
| PMID: | 37080190 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1424-3997 |
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| DOI: | 10.57187/smw.2023.40056 |