Evidence map›Paper›PMID 41634587›Full record

SynthesisBMC cardiovascular disorders2026

Direct oral anticoagulants versus vitamin K antagonists for postoperative atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of randomized controlled trials.

Omer Abdalhaleem Omer Ahmed, Mahmood Abbas, Ali Abdelhaleem Omar Ahmed, Mamdoh Abbas Ali Ibrahim, Mugtaba Eltag Mohammed Abakar, Elhaitham Yasir, Mohamed Elfatih Esameldin Edris, Reem Abdelhaleem Omar Ahmed, Rana Abdelhaleem Omar Ahmed, Mojahid Babkir and 4 more

Abstract readSystematic ReviewMeta-Analysis
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMC cardiovascular disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

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Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

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5 · Who and what money

Authors and funding

14 authors.

Omer Abdalhaleem Omer AhmedFaculty of Medicine, University of Khartoum, Khartoum, Sudan.
Mahmood AbbasFaculty of Medicine, National Ribat University, Khartoum, Sudan.
Ali Abdelhaleem Omar AhmedFaculty of Medicine, National Ribat University, Khartoum, Sudan. ali7haleem@gmail.com.
Mamdoh Abbas Ali IbrahimFaculty of Medicine, Sudan International University, Khartoum, Sudan.
Mugtaba Eltag Mohammed AbakarFaculty of Medicine, Sudan International University, Khartoum, Sudan.
Elhaitham YasirFaculty of Medicine, National Ribat University, Khartoum, Sudan.
Mohamed Elfatih Esameldin EdrisFaculty of Medicine, National Ribat University, Khartoum, Sudan.
Reem Abdelhaleem Omar AhmedFaculty of Medicine, National Ribat University, Khartoum, Sudan.
Rana Abdelhaleem Omar AhmedFaculty of Medicine, National Ribat University, Khartoum, Sudan.
Mojahid BabkirFaculty of Medicine, Sudan International University, Khartoum, Sudan.
Mohamed Adil Mubarak AbdulazizFaculty of Medicine, University of Khartoum, Khartoum, Sudan.
Henry A SotaSt. Georges University, St. Georges, Grenada.
Collins GilbertSt. Georges University, St. Georges, Grenada.
Ahmed Ashraf EissaCardiac Academy, Ain Shams University, Cairo, Egypt.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundPostoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. Although direct oral anticoagulants (DOACs) have revolutionized stroke prevention in non-surgical atrial fibrillation, their role relative to vitamin K antagonists (VKAs) specifically in POAF is unclear.

methodsA systematic review and meta-analysis were performed from randomized controlled trials comparing DOACs (apixaban, rivaroxaban, or dabigatran) vs. VKAs in adult patients with POAF following cardiac surgery. The primary outcomes included stroke/systemic embolism as an efficacy endpoint and major bleeding as a safety endpoint. Secondary outcomes comprised any bleeding and cost-effectiveness. We searched the following databases: PubMed, Scopus, Cochrane Central, and Google Scholar from inception through November 2025. The study protocol was registered with PROSPERO (Registration number: CRD420251249764).

resultsFour randomized controlled trials (RCTs) were included (n = 202 patients). Stroke/systemic embolism occurred in 1.0% (1/103) of DOAC patients versus 1.0% (1/99) of VKA patients (RR 0.80, 95% CI 0.06–11.5; P = 0.87). Major bleeding occurred in 1.9% (2/103) versus 4.0% (4/99) (RR 0.55, 95% CI 0.11–2.64; P = 0.46). Any bleeding occurred in 10.7% (11/103) versus 11.1% (11/99) (RR 1.01, 95% CI 0.31–3.30; P = 0.99). Two trials reported lower costs with DOACs in their local settings, though these findings are exploratory and not generalizable.

conclusionAmong patients with POAF following cardiac surgery, DOACs appear to have efficacy and safety profiles similar to those of VKAs, with non-significant trends toward lower major bleeding rates. Reported cost advantages are preliminary and context-specific. These findings are based on a small number of trials with limited sample sizes and very low event rates, and do not demonstrate equivalence; they warrant confirmation in larger, adequately powered studies.

Indexed as

AnticoagulantsAntithrombinsAtrial FibrillationCardiac Surgical ProceduresFactor Xa InhibitorsStrokeVitamin KAdministration, OralAgedCost-Benefit AnalysisDrug CostsFemaleHemorrhageHumansMaleMiddle AgedAnticoagulantsAntithrombinsFactor Xa InhibitorsVitamin KCardiac surgeryDirect oral anticoagulantsMeta-analysisPostoperative atrial fibrillationVitamin K antagonists

Identifiers

PMID41634587
PMCPMC12964950

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.