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

Inclusion Criteria:

1. noncardiac surgery in the past 35 days with at least one of the following:

2. an overnight hospital admission after surgery;

3. day surgery resulting in a large enough physiological insult to be able tocause perioperative AF, as judged by the local investigator

4. ≥1 episode of clinically important perioperative AF during or after their surgery;

5. sinus rhythm at the time of randomization; AND

6. any of the following high-risk criteria:

7. age 55-64 years, and having either known cardiovascular disease, recent majorvascular surgery, a CHA2DS2VASc score ≥3, or an elevated postoperative troponinlevel;

8. age 65-74 years, and having either known cardiovascular disease, recent majorvascular surgery, a CHA2DS2VASc score ≥2, or an elevated postoperative troponinlevel; OR

9. age ≥75 years.

10. provide written informed consent

Exclusion Criteria:

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 nottaking effective contraception; OR

14. previously enrolled in the trial