ABSTRACT
Postoperative atrial fibrillation (POAF) is a common complication, with an incidence ranging from 1–50% depending on the type of surgery and proximity of the procedure to the heart. Acute management of POAF involves traditional principles including either rate control and/or rhythm control to help mitigate palpitations, shortness of breath, and other manifestations of heart failure. Anticoagulation for POAF, however, is a far more complex and nuanced topic. Anticoagulation for atrial fibrillation in the non-surgical setting is determined based on a patient's risk factors for thromboembolism. There is no literature to guide anticoagulation management for POAF after non-cardiac surgery. Randomized clinical trials are underway to determine the appropriate use and timing of anticoagulation for the vulnerable population at both high stroke and high bleeding risk. Atrial fibrillation after cardiac surgery has the greatest POAF risk, with approximately 30% of patients developing POAF after coronary artery bypass grafting and 50% after valve surgery.
