Over 27 million Americans undergo noncardiac surgery annually. However, despite having noncardiac surgery, cardiac complications can still be a major source of morbidity and mortality in the perioperative period if you suffer from atrial fibrillation.
Patients who are taking anticoagulants – including patients with afib - undergoing any surgery is taken off these blood thinning medications prior to the procedure to avoid bleeding and serious complications. The focus of preoperative evaluation if you have afib is to:
(1) assess your rate and/or rhythm control;
(2) identify patients with valvular disease or heart failure;
(3) determine if you have experienced prior thromboembolic events; and
(4) take a thorough history of previous management plans you used when cessation of anticoagulation was required.
Your physician will also perform a thorough cardiovascular examination, including a review of your ECG and prior echocardiograms. It is also important for your physician to know about prior factors that induced afib episodes, including any episodes occurring with prior surgical procedures.
Preoperative management includes optimizing the heart rate, which is individualized according to your needs. AV nodal blockers are typically continued around the time of surgery, and a post-op plan should be made for continuing these agents, taking into account whether or not oral food and fluids will be withheld from you after the procedure (if you are "NPO"). Your preoperative management should generally include a discussion with your cardiologist if you are receiving antiarrhythmic medications, such as sotalol, propafenone, and amiodarone.
The use of anticoagulation around the time of your surgery requires complex decision making. A plan should be developed prior to surgery whenever possible. This plan should include anticipating the postoperative conditions affecting the resumption of anticoagulation.
The management of anticoagulation when you are undergoing surgical procedures is challenging because interrupting anticoagulation for a procedure increases your risk of forming blood clots that can be carried to other vessels in your body (thromboembolism), which can lead to a more serious condition or death. At the same time, surgery and invasive procedures have associated bleeding risks that are increased by the anticoagulant(s) you take for thromboembolism prevention. A balance between reducing the risk of thromboembolism and preventing excessive bleeding must be reached.
If you are being treated for atrial fibrillation and will be undergoing any type of surgery, talk your doctor about management of your afib and blood thinners around the time of surgery.
Dr. Rishi Anand is a cardiac electrophysiologist with the Holy Cross Medical Group in Fort Lauderdale, FL and serves as medical director of Holy Cross Hospital's Electrophysiology Lab. For physician referral information, call 954-900-6659.