Novel oral anticoagulants vs warfarin for the management of postoperative atrial fibrillation: clinical outcomes and cost analysis.
BACKGROUND
The novel oral anticoagulants (NOACs) apixaban, rivaroxaban, and dabigatran are indicated for the treatment of nonvalvular atrial fibrillation, but their use in patients with postoperative atrial fibrillation (POAF) is less well defined.


METHODS
All patients undergoing isolated coronary artery bypass grafting from 2013 to 2015 (n = 598) were studied. Patients with POAF anticoagulated with either warfarin or NOACs were evaluated for differences in length of stay, blood product use, bleeding, and cost of therapy.


RESULTS
There was no significant difference between the NOAC and warfarin group for any of the clinical outcomes evaluated. Time to therapeutic anticoagulation was significantly longer with warfarin. Neither group had a major bleeding event during the initial hospitalization, but 2 patients in the warfarin group had delayed major bleeding complications. Total costs were significantly reduced in patients treated with NOACs.


CONCLUSIONS
Both NOACs and warfarin are safe and effective means of anticoagulation for POAF after coronary artery bypass grafting. Patients were therapeutic more rapidly and with less cost of treatment when NOACs were used.
Department of Surgery, University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, Grand Forks, ND 58203-9037, USA.
Eric
E
Anderson
Department of Pharmacology, Sanford Health Fargo, 801 Broadway North, Fargo, ND 58122, USA.
Katie
K
Johnke
Department of Pharmacology, Sanford Health Fargo, 801 Broadway North, Fargo, ND 58122, USA.
David
D
Leedahl
Department of Surgery, University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, Grand Forks, ND 58203-9037, USA.
Matthew
M
Glogoza
Department of Pharmacology, Sanford Health Fargo, 801 Broadway North, Fargo, ND 58122, USA.
Roxanne
R
Newman
Department of Surgery, University of North Dakota School of Medicine & Health Sciences, 501 North Columbia Road Stop 9037, Grand Forks, ND 58203-9037, USA; Department of Pharmacology, Sanford Health Fargo, 801 Broadway North, Fargo, ND 58122, USA. Electronic address: Cornelius.Dyke@sanfordhealth.org.
Cornelius
C
Dyke
D000284:Administration, Oral; D000368:Aged; D000925:Anticoagulants / Q000191:economics / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000188:drug therapy* / Q000209:etiology; D016913:Blood Component Transfusion / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass; D000069604:Dabigatran / Q000191:economics / Q000627:therapeutic use; D016527:Drug Costs; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011720:Pyrazoles / Q000191:economics / Q000627:therapeutic use; D011728:Pyridones / Q000191:economics / Q000627:therapeutic use; D000069552:Rivaroxaban / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome; D014859:Warfarin / Q000191:economics / Q000627:therapeutic use*
D000925:Anticoagulants; D011720:Pyrazoles; D011728:Pyridones; C522181:apixaban; D014859:Warfarin; D000069552:Rivaroxaban; D000069604:Dabigatran
Anticoagulation; Novel oral anticoagulants; Postoperative atrial fibrillation; Warfarin