Cardiology Research and Practice

Review Article

Management Strategies in Cardiac Surgery for Postoperative Atrial Fibrillation: Contemporary Prophylaxis and Futuristic Anticoagulant Possibilities

Table 4

Overview of the included upstream therapy studies.
DrugAuthor Ref.YearDesignOutcomes of InterestStudy N DesignPatients N ResultsP value NNT
(95% CI)		Bottom line
InterventionControlOdds Ratio (95% CI)
Magnesium Arsenault et al. [43] 2013 MAPOAF21 RCTs156714210.55 (0.41 to 0.73)<0.000111 (8–15)Magnesium is beneficial
Stroke3 RCTs3803800.33 (0.03 to 3.20)0.34NANo significant decrease in stroke
Mortality12 RCTs9078570.83 (0.31 to 2.24)0.72NANo significant decrease in mortality
CV mortality9 RCTs5024600.53 (0.09 to 3.13)0.49NANo significant decrease in CV mortality
Length of stay9 RCTs7987910.05 days (−0.47 to 0.57) 0.86NANo significant decrease in length of stay
Shepherd et al.[49]2008MAPOAF15 RCTs107010310.65 (0.53 to 0.79)<0.000113 (8–22)Magnesium is beneficial
Statins Liakopoulos et al. [50] 2012 MAPOAF11 RCTs 422419 0.40 (0.29 to 0.55)<0.000017 (4–9)Statins are beneficial
Mortality1 RCT101990.98 (0.14 to 7.10)0.98NANo significant decrease in mortality
Stroke2 RCTs1331310.70 (0.14 to 3.63)0.67NANo significant decrease in stroke
ICU stay7 RCTs263258−3.39 hrs (−5.77 to −1.01)0.0052NAShorter ICU and length of stay
Length of stay8 RCTs442435−0.48 days (−0.85 to −0.11) 0.011NA 
Chopra et al.[51] 2012MAPOAF9 RCTs467466 0.56 (0.45 to 0.69) <0.00017 (5–9) Statins are beneficial
Chen et al. [52] 2010 MAPOAF8 RCTs 326325 0.57 (0.45–0.72)0.00066 (4–10)Statins are beneficial
ICU stay5 RCTs167164−0.17 hrs (−0.37 to 0.03)NANAShorter ICU and length of stay
Length of stay6 RCTs687 −0.66 days (−1.01 to −0.30)NANA
Corticosteroids Ho and Tan [53] 2009 MAPOAF17 RCTs752757 0.74 (0.63 to 0.86)0.000110 (7–19)Corticosteroids are beneficial
Infection22 RCTs806802 0.93 (0.61 to 1.41)0.73NANo increase in infection (but more hyperglycemia needing insulin, 28% RR)
Mortality35 RCTs140713790.72 (0.45 to 1.14)0.16NAIncreased hyperglycemia when utilization of high doses
Hyperglycemia9 RCTs2552481.49 (1.11 to 2.01) 0.009NNH = 9 (5–25) Dose did not affect the outcome
Dieleman et al. [54] 2011 MAPOAF17 RCTs6946950.60 (0.46 to 0.78)0.0001613 (8–28)Corticosteroids are beneficial
Stroke10 RCTs5385140.70 (0.33 to 1.48)0.35NANo significant impact on stroke, mortality,
Mortality17 RCTs10369761.12 (0.65 to 1.92)0.68NAand infections
Infections15 RCTs7447430.86 (0.56 to 1.31)0.47NAShorter ICU and hospital stay
ICU stay25 RCTs605610−2.32 hrs (−2.84 to −1.81)<0.00001NA 
Hospital stay15 RCTs312313−0.40 days (−0.65 to −0.15) 0.0017NA 
Dieleman et al. [55] 2012 RCTPOAF1 RCT223522470.94 (0.87 to 1.02)0.14NACorticosteroids are not beneficial
Stroke1 RCT223522470.91 (0.55 to 1.50)0.72NADecreased risk of infection
Mortality1 RCT223522470.92 (0.57 to 1.49)0.73NANo significant impact on stroke
Infection1 RCT223522470.64 (0.54 to 0.75)<0.00119 (14–29)No significant impact on mortality
Length of stay1 RCT22352247NA0.009NAShorter ICU and hospital stay
ICU stay1 RCT22352247NA<0.001NAIncreased risk of hyperglycemia
Hyperglycemia1 RCT22352247NA<0.001NA
ω-3-PUFAs Mozaffarian et al. [56] 2012 RCTPOAF1 RCT7587580.96 (0.77 to 1.20)0.74NAω-3-PUFAs are not beneficial
Stroke1 RCT7587580.45 (0.13 to 1.51)0.18NANo significant decrease in stroke
Mortality1 RCT7587580.53 (0.23 to 1.26)0.14NA No significant decrease in (CV) mortality
CV mortality1 RCT758758NA0.08NANo significant decrease in hospital stay
Hospital stay1 RCT758758NA0.48NA 
Liu et al.[57]2011MAPOAF10 RCTs 977978 0.81 (0.57 to 1.15)0.24NAω-3-PUFAs are not beneficial
Mozaffarian et al.[58]2013MAPOAF8 RCTs2717NA0.85 (0.72 to 1.00)0.24NAω-3-PUFAs are not beneficial
POAF: postoperative atrial fibrillation; NA: Not applicable; NNT: number needed to treat; NNH: number needed to harm; hrs: hours; ref.: reference; postop: postoperative; preop: preoperative; RCT: randomized control trial; MA: meta-analysis.