Non–vitamin K oral anticoagulant use after cardiac surgery is rapidly increasing.

The prevalence of non–vitamin K oral anticoagulant use after cardiac surgery is unknown, particularly in patients with bioprosthetic valves. We sought to define the contemporary use and short-term safety of non–vitamin K oral anticoagulants after cardiac surgery. All patients undergoing bioprosthetic aortic valve replacement, bioprosthetic mitral valve replacement, or isolated coronary artery bypass grafting (2011-2018) were evaluated from a multicenter, regional Society of Thoracic Surgeons database. Patients were stratified by anticoagulant type (non–vitamin K oral anticoagulant vs vitamin K antagonist) and era (early [2011-2014] vs contemporary [2015-2018]). Of 34,188 patients, 18% (6063) were discharged on anticoagulation, of whom 23% were prescribed non–vitamin K oral anticoagulants. Among those receiving anticoagulation, non–vitamin K oral anticoagulant use has significantly increased from 10.3% to 35.4% in contemporary practice (P <.01). This trend was observed for each operation type (coronary artery bypass grafting 0.86%/year, bioprosthetic aortic valve replacement: 2.15%/year, bioprosthetic mitral valve replacement: 2.72%/year, all P <.01). In patients with postoperative atrial fibrillation receiving anticoagulation, non–vitamin K oral anticoagulant use has increased from 6.3% to 35.4% and 12.3% to 40.3% after bioprosthetic valve replacement and isolated coronary artery bypass grafting, respectively (both P <.01). In patients receiving anticoagulation at discharge, adjusted 30-day mortality (odds ratio, 1.94; P =.12) and reoperation (odds ratio, 0.79; P =.34) rates were not associated with anticoagulant choice, whereas non–vitamin K oral anticoagulant use was associated with an adjusted 0.9-day decrease (P <.01) in postoperative length of stay. Non–vitamin K oral anticoagulant use after cardiac surgery has dramatically increased since 2011. This trend is consistent regardless of indication for anticoagulation including bioprosthetic valves. Short-term outcomes support their safety in the cardiac surgery setting with shorter postoperative hospital stays. Long-term studies on the efficacy of non–vitamin K oral anticoagulants after cardiac surgery are still necessary. The study population included more than 34,000 patients in the VCSQI. Over time, the use of NOACs has increased significantly for all included subgroups. Risk-adjusted outcomes after cardiac surgery are similar to patients being prescribed VKAs with an associated reduction in length of stay. [ABSTRACT FROM AUTHOR]