From the Guidelines
Eliquis (apixaban) is typically not indicated for continued use 6 months after cardiac surgery if the atrial fibrillation was only a post-operative complication that has since resolved. For most patients who develop post-operative atrial fibrillation (POAF) after cardiac surgery, anticoagulation therapy is usually discontinued after 4-12 weeks if normal sinus rhythm has been restored and maintained 1. However, if the patient has other risk factors for stroke (such as high CHA₂DS₂-VASc score, persistent atrial fibrillation, or recurrent episodes), longer-term or indefinite anticoagulation may be warranted. The decision to continue or discontinue Eliquis should be made based on an individualized assessment of the patient's stroke risk versus bleeding risk. Factors to consider include:
- Whether the atrial fibrillation has completely resolved
- The patient's overall stroke risk profile
- Any history of bleeding complications Regular follow-up with electrocardiogram monitoring is important to confirm that normal rhythm has been maintained. Patients should not stop Eliquis without consulting their cardiologist or cardiac surgeon, as abrupt discontinuation could increase stroke risk if atrial fibrillation is still present. According to the 2020 ACC expert consensus decision pathway, the management of anticoagulant and antiplatelet therapy in patients with atrial fibrillation or venous thromboembolism undergoing percutaneous coronary intervention or with atherosclerotic cardiovascular disease should be individualized 1.
In terms of specific guidelines, the Chest guideline and expert panel report recommends therapeutic anticoagulation for at least 4 weeks after successful cardioversion to sinus rhythm, but decisions about anticoagulation beyond 4 weeks should be made in accordance with risk-based recommendations for long-term antithrombotic therapy 1. Therefore, the continuation of Eliquis beyond 6 months after cardiac surgery should be based on the patient's underlying stroke risk and not solely on the presence of post-operative atrial fibrillation. The patient's cardiologist or cardiac surgeon should reassess the patient's risk profile and make an informed decision about the continuation or discontinuation of Eliquis.
From the Research
Indications for Eliquis (Apixaban) after Cardiac Surgery
- The provided studies do not directly address whether Eliquis (apixaban) is still indicated 6 months after cardiac surgery for postoperative atrial fibrillation (A fib) 2, 3, 4, 5, 6.
- However, the studies suggest that postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery, occurring in up to 40% of patients, and is associated with increased morbidity and mortality 3, 4, 6.
- The management of POAF includes both prophylactic and therapeutic measures, such as rate or rhythm control, antithrombotic therapy, and oral anticoagulation 2, 4, 5.
- The decision to continue anticoagulation therapy, including Eliquis (apixaban), after cardiac surgery would depend on the individual patient's risk factors, such as history of stroke or transient ischemic attack, and the presence of other conditions that may increase the risk of thromboembolism 2, 5.
- Some studies suggest that patients with POAF may require short-term oral anticoagulation for stroke prevention, but the long-term significance of POAF is unclear 5.
Risk Factors and Management
- Advanced age, pre-existing conditions that cause cardiac remodelling, and certain non-cardiovascular conditions are risk factors for POAF 4.
- Clinical management of POAF includes both prophylactic and therapeutic measures, although the efficacy of many interventions remains in question 4.
- Treatment for POAF is variable and is associated with particular morbidity and mortality following cardiac surgery 6.
- Patients with POAF are more likely to experience complications, including acute limb ischemia, stroke, and reoperation 6.