Vol 25, No 1-2 (2023)
Review paper
Published online: 2024-09-13
Preparing a patient with atrial fibrillation for non-cardiac surgery
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, 2, 23, 23, 23
, 2, 23, 23, 23
DOI: 10.5603/chp.97603
Chirurgia Polska 2023;25(1-2):48-54.
Abstract
Atrial fibrillation (AF) is the most common arrhythmia worldwide and poses a significant public health challenge. Patients with AF who require surgery present a clinical challenge. This article reviews issues related to preparing AF patients for non-cardiac surgery (NCS). The ABC approach can be implemented to optimize the preparation of AF patients for NCS, which involves stroke prevention (anticoagulation therapy), symptom control, and management of comorbidities. Anticoagulation therapy significantly reduces the risk of stroke in AF patients, and the choice of anticoagulant depends on bleeding risk and creatinine clearance. Discontinuation of anticoagulation therapy before surgery may be necessary and depends on the type of procedure and the specific anticoagulant used. Heart rhythm or rate control are two strategies for managing AF patients. Early rhythm control therapy can improve the quality of life for patients and reduce the risk of adverse cardiovascular outcomes. However, precise patient monitoring and “tailored” treatment are crucial. Preparing AF patients for non-cardiac surgery requires a comprehensive risk assessment and individualized approach. The clinical value of AF, bleeding risk, and the type of surgery and anesthesia should be considered to improve surgical outcomes for AF patients.
Keywords: atrial fibrillationnon-cardiac surgeryanticoagulation
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