Effectiveness of Anti-Inflammatory Agents to Prevent Atrial Fibrillation After Cardiac Surgery: A Systematic Review and Network Meta-Analysis.

Summary

Across 85 trials (n=18,981), NSAIDs and statins probably reduce new-onset POAF after cardiac surgery without affecting mortality or serious adverse events. Fish oil with vitamins C/E, colchicine, corticosteroids, and N-acetylcysteine may also help, but with lower certainty.

Key Findings

• NSAIDs reduced POAF risk vs placebo: RR 0.37 (95% CI 0.23–0.59), moderate certainty.
• Statins reduced POAF risk vs placebo: RR 0.56 (95% CI 0.45–0.70), moderate certainty.
• Fish oil + vitamins C/E (RR 0.30), colchicine (RR 0.62), corticosteroids (RR 0.70), and N-acetylcysteine (RR 0.69) may reduce POAF with low certainty; no effect on mortality or serious adverse events.

Clinical Implications

Consider incorporating NSAIDs or statins into perioperative protocols for cardiac surgery patients at risk of POAF, while balancing bleeding, renal, or hepatic risks. Routine use should be individualized and aligned with cardiology/anesthesiology teams.

Limitations

• Certainty for several agents (e.g., fish oil+vitamins, colchicine, corticosteroids, NAC) was low
• Heterogeneity in dosing, timing, and patient selection; no mortality benefit detected

Future Directions

Head-to-head pragmatic RCTs comparing NSAID and statin strategies, safety profiling (bleeding, renal), and integration into ERAS pathways; biomarker-driven risk stratification for POAF prevention.