title: Guideline adherence in antithrombotic treatment after concomitant ablation surgery in atrial fibrillation patients.
abstract: OBJECTIVE
  We investigated real-life oral anticoagulation (OAC) treatment after surgical ablation and examined its adherence to current recommendations. We also explored factors related to OAC use preoperatively and at follow-up.
  
  
  METHODS
  One hundred and fifteen patients with atrial fibrillation (AF) were evaluated during 12-month follow-up after surgery. Patients were divided into two categories according to the congestive heart failure, hypertension, age ≥75 years, diabetes and prior stroke [or transient ischaemic attack or thromboembolism] (CHADS2) score: 60 patients were assigned to the high-risk group (CHADS2 score ≥2) and 55 to the low-risk group (CHADS2 score ≤1). OAC use was defined as guideline adherent, undertreatment or overtreatment.
  
  
  RESULTS
  Baseline overall guideline adherence was 62%. OAC was underprescribed in high-risk patients and overprescribed in low-risk patients (both, P < 0.001). The only factor associated with OAC use after logistic regression analysis were age >75 years (P = 0.01) and preoperative AF > paroxysmal (P = 0.013). Overall guideline adherence at 12-month follow-up showed a trend towards a better adherence in the sinus rhythm (SR) subgroup (74% vs 55%, P = 0.02). OAC was underprescribed in high-risk patients and overprescribed in low-risk patients (both P < 0.001). After logistic regression analysis, preoperative OAC use (P = 0.007) and other indications for OAC (P = 0.01) were predictors of anticoagulation treatment.
  
  
  CONCLUSIONS
  Real-life OAC prescription in AF patients showed a moderate guideline adherence, with high-risk patients being undertreated and low-risk patients being overtreated. These findings stress the importance that antithrombotic treatment in patients undergoing AF surgery needs to be critically re-evaluated.
authors: Cardiothoracic Surgery and Cardiology, University Hospital, Maastricht, Netherlands.
authors: Henrica N A M
authors: HN
authors: van Breugel
authors: Sandro
authors: S
authors: Gelsomino
authors: Pieter W J
authors: PW
authors: Lozekoot
authors: Ryan E
authors: RE
authors: Accord
authors: Fabiana
authors: F
authors: Lucà
authors: Orlando
authors: O
authors: Parise
authors: Harry J G M
authors: HJ
authors: Crijns
authors: Jos G
authors: JG
authors: Maessen
mesh_terms: D055011:Ablation Techniques / Q000009:adverse effects; D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000601:surgery*; D016009:Chi-Square Distribution; D017723:Drug Utilization Review / Q000592:standards; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents
keywords: Ablation surgery; Anticoagulation; Atrial fibrillation