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Invited Commentary
May 2018

Late Stroke After Coronary Artery Bypass Grafting

Author Affiliations
  • 1Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
JAMA Cardiol. 2018;3(5):425-426. doi:10.1001/jamacardio.2018.0534

The use of oral anticoagulation therapy to prevent stroke in patients with atrial fibrillation (AF) is one of the most successful therapies in cardiovascular and stroke medicine.1 The introduction of direct oral anticoagulants has increased the ease and safety of delivering this therapy1; thus, there is a strong motivation to deliver this therapy to patients at risk of AF-related stroke. More than 2 million cardiac surgeries are performed each year, and 20% to 30% of these patients develop postoperative AF.2 Although most of these patients have traditional AF and stroke risk factors,2 it is postulated that much of this AF may be transient, the result of both local inflammation and a systemic inflammatory response.3 Clinicians speculate that AF may be self-limited in patients following cardiac surgery similar to other situations of transient stress, such as medical illness and noncardiac surgery,4 and thus long-term treatment with oral anticoagulation therapy may not be necessary.