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(Chest. 2005;128:24S-27S.)
© 2005 American College of Chest Physicians

Anticoagulation*

American College of Chest Physicians Guidelines for the Prevention and Management of Postoperative Atrial Fibrillation After Cardiac Surgery

Andrew E. Epstein, MD; John C. Alexander, MD; David D. Gutterman, MD, FCCP; William Maisel, MD, MPH and J. Marcus Wharton, MD

* From the University of Alabama at Birmingham (Dr. Epstein), Birmingham, AL; Hackensack University Medical Center (Dr. Alexander), Hackensack, NJ; the Medical College of Wisconsin (Dr. Gutterman), Milwaukee, WI; Harvard University (Dr. Maisel), Boston, MA; and the Medical University of South Carolina (Dr. Wharton), Charleston, SC.

Correspondence to: Andrew E. Epstein, MD, Division of Cardiovascular Disease, Department of Medicine, The University of Alabama at Birmingham, Tinsley Harrison Tower 321L, 1530 Third Ave South, Birmingham, AL 35294-0006; e-mail: aepstein{at}uab.edu

Post-cardiac surgery atrial fibrillation (AF) places patients at risk for thromboembolism and stroke, while the surgery and cardiopulmonary bypass alter the multiple factors of coagulation and may increase the tendency to bleed. It is in the context of this complex clinical picture that the physician must make decisions regarding the risks and benefits of anticoagulation therapy to lower the risk for thromboembolism and stroke associated with postoperative AF. Physicians must also weigh the usually transient and self-limited duration of new-onset postoperative AF against the potential for postoperative bleeding if anticoagulation therapy is started. No randomized, controlled clinical trials are available that specifically address the problem of anticoagulation therapy for the postoperative AF. In that context, recommendations are based on the established therapy for nonsurgical situations modified by the potential risk of bleeding in the postoperative patient.






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