Table 4. Recent meta-analyses concerning perioperative atrial fibrillation (e6, e12– e15).
| Study | Methods | Findings | Comments |
|
Jing et al./2022 (e14) effects of dexmedetomidine on the occurrence of PAF and stroke after cardiac surgery |
18 RCTs with a total of 2933 patients |
– dexmedetomidine lowered the frequency of PAF (OR = 0.82; 95% CI: [0.69; 0.98]; p = 0.03) – no effect on the frequency of stroke, duration of hospitalization, need for mechanical ventilation and intensive care, or mortality |
Dexmedetomidine lowers the frequency of PAF but has no further clinical benefit. |
| Kim et al./2021 (e12)effects of β-blockers after cardiac surgery | 13 trials (5 randomized, 8 non-randomized) with a total of 25 496 patients |
– PAF arose significantly less frequently in patients receiving β-blockers (analysis of randomized trials: OR = 0.56; 95% CI: [0.35; 0.91]) – analysis of nonrandomized trials: OR = 0.70; 95% CI: [0.55; 0.91] – no effect on hospitalization, stroke, or mortality |
β-blockers lower the frequency of PAF but have no further clinical benefit. |
| Siddiqui et al./2020 (e13)perioperative bridging in pateints with PAF | 3 studies (2 randomized trials, 1 observational study) with a total of 6305 patients |
– perioperative bridging did not lessen the frequency of thomboembolic events (RR = 1.25; 95% CI: [0.55; 2.85]) but did significantly elevate the risk of severe hemorrhage (RR = 3.29; 95% CI: [2.25; 4.81]) | The perioperative bridging of patients with PAF who take OAC does not seem to be beneficial. |
| Lin et al./2019 (e6)association of stroke and mortality with PAF | 35 cohort studies with a total of 2 458 010 patients |
– PAF was associated with elevated stroke risk and increased mortality (stroke 0–30 days post-op: OR = 1.62; 95% CI: [1.47; 1.80]; death 0–30 days post-op: OR = 1.44; 95% CI: [1.11; 1.88] – stroke >30 days post-op: HR = 1.37; 95% CI: [1.07; 1.77]; death >30 days post-op: HR = 1.37; 95% CI: [1.27; 1.49] |
Observation without targeted intervention, such as postoperative screening for VHF recurrence/systemic OACs. |
| Nazha et al./2018 (e15)periprocedural comparison of the safety and efficacy of DOAC and VKA | 4 RCTs (including subtrials) with a total of 19 353 patients |
– significantly fewer hemorrages occurred with uninterrupted periprocedural administration of DOACs compared with VKA (2.0% versus 3.3%; RR = 0.62; 95% CI: [0.47; 0.82]) – there was no difference in the frequency of stroke or death |
DOACs seem to be safter than VKA when given periprocedurally without interruption. |
AF, atrial fibrillation; CI, confidence interval; DOAC, direct oral anticoagulant drug; HR, hazard ratio; OAC, oral anticoagulant drug; OR, odds ratio; PAF, perioperative atrial fibrillation; RR, relative risk; VKA, vitamin K antagonists