AB234. SOH26AB_0019. The impact of anticoagulation management in atrial fibrillation on perioperative care

Background: It is estimated that over 11% of people over the age of 80 years in Ireland have atrial fibrillation (AF). The aim of AF management focuses on symptom control and stroke prevention, using rate-controlling agents and anti-coagulants. These medications can lead to various adverse events such as haemorrhages or falls, often leading to the need for urgent surgical intervention. Although there are set guidelines for the perioperative management of anti-coagulation therapy outlined by the European Heart Rhythm Association, there is some evident apprehension among physicians to stop anti-coagulants in patients with AF. This is exacerbated by the fact that many AF patients have complicated medical histories with long lists of co-morbidities. We aimed to assess the impact of anticoagulation management in AF in postoperative care.

Methods: We conducted a cross-sectional snapshot study of 100 inpatients over a 6-week period who had a diagnosis of AF. The primary outcomes included reason for admission, adverse side effects from anticoagulant use, and surgical delays and issues because of anticoagulant use. Those under the care of cardiology or cardiothoracic surgery were excluded. Descriptive and inferential statistical analysis was performed on the collected data using SPSS version 30 with significance set at P>0.05.

Results: There was 87% of patients currently taking factor Xa inhibitors for their AF. Of those on medications for AF, 37% reported adverse side effects, mainly excessive bruising and inappropriate bleeding. 89% of the patient population had needed surgery at some point, and 50% of the patients had been taking anticoagulants at the time of the surgery. Of the patients on anti-coagulants at the time of surgery, 87.7% reported issues with the main issue being delays to surgical intervention because of their anticoagulation therapy. The main categories of surgical intervention required were general surgery (36%), orthopaedic surgery (18%), and cardiac (including cardiology procedures) (10%). Patients who had had a procedural intervention for their AF were significantly more likely to have had issues with their surgery compared to those who had only ever been managed medically (79.2% vs. 40.8%, P>0.004).

Conclusions: Anticoagulant use in AF management has a negative effect on patients’ perioperative planning.

Keywords: Anticoagulation; atrial fibrillation (AF); perioperative care; adverse effects; rate control