Anticoagulation for Stroke Prevention In Patients With Recent Episodes of Perioperative AF After Noncardiac Surgery

Eligibility Criteria

• 1. noncardiac surgery in the past 35 days with at least one of the following:
• 1. an overnight hospital admission after surgery;
• 2. day surgery resulting in a large enough physiological insult to be able to cause perioperative AF, as judged by the local investigator
• 2. ≥1 episode of clinically important perioperative AF during or after their surgery;
• 3. sinus rhythm at the time of randomization; AND
• 4. any of the following high-risk criteria:
• 1. age 55-64 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥3, or an elevated postoperative troponin level;
• 2. age 65-74 years, and having either known cardiovascular disease, recent major vascular surgery, a CHA2DS2VASc score ≥2, or an elevated postoperative troponin level; OR
• 3. age ≥75 years.
• 5. provide written informed consent
• 1. history of documented chronic AF prior to noncardiac surgery;
• 2. need for long-term systemic anticoagulation;
• 3. ongoing need for long-term dual antiplatelet treatment;
• 4. contraindication to oral anticoagulation;
• 5. severe renal insufficiency (CrCl \<20 ml/min);
• 6. severe liver cirrhosis (i.e., Child-Pugh Class C)
• 7. acute stroke in the past 14 days;
• 8. underwent cardiac surgery in the past 35 days;
• 9. history of nontraumatic intracranial, intraocular, or spinal bleeding;
• 10. hemorrhagic disorder or bleeding diathesis;
• 11. expected to be non-compliant with follow-up and/or study medications;
• 12. known life expectancy less than 1 year due to concomitant disease;
• 13. women who are pregnant, breastfeeding, or of childbearing potential who are not taking effective contraception; OR
• 14. previously enrolled in the trial