Recommendations of professional societies
| Professional society | Recommendations | Class of recommendations/level of evidence |
|---|---|---|
| AHA/ACC/HRS22,23 | It is reasonable to administer antithrombotic medication in patients who develop postoperative AF, as recommended for nonsurgical patients | Class IIA: (benefit greater than risk, additional studies with focused objectives needed, it is reasonable to administer treatment Level of Evidence: B (limited population evaluated, data derived from a single randomized trial or nonrandomized studies) |
| ACCP28 | A: Postoperative use of heparin in high-risk patient | Strength of recommendation: C Evidence grade: Low Net benefit: Intermediate |
| B: Postoperative use of warfarin in patient with chronic AF and in whom it is thought likely that AF will continue | Strength of recommendation: A Evidence grade: Good Net benefit: Substantial | |
| C: Duration of anticoagulation therapy is 30 days after return of sinus rhythm | Strength of recommendation: C Evidence grade: Low Net benefit: Intermediate | |
| CCS29 | Anticoagulation is recommended for patients with prolonged (≥ 72 hours) AF Once initiated, anticoagulation is usually continued for 6 weeks | Low-quality evidence |
| EACTS30 | A: After cardiac surgery, patients with AF should be anticoagulated while in AF, and full anticoagulation should be started within 48 hours of AF onset due to doubling of risk of stroke This can be achieved with warfarin (INR 2–3), intravenous heparin, or full-dose low-molecular-weight heparin | Grade A recommendation based on level 1A studies |
| B: Immediate full anticoagulation in patients going into AF within 48 hours of their operation is not supported due to increased risk of cardiac tamponade | Grade C recommendation based on an individual level 2B study | |
| C: There is insufficient evidence to recommend whether patients who suffer from an episode of AF after cardiac surgery but who return to sinus rhythm will benefit from further 4 to 6 weeks of anticoagulation | Grade E recommendation based on expert consensus |
ACC = American College of Cardiology; ACCP = American College of Chest Physicians; AF = atrial fibrillation; AHA = American Heart Association; CCS = Canadian Cardiovascular Society; EACTS = European Association for Cardio-Thoracic Surgery; HRS = Heart Rhythm Society; INR = international normalized ratio