Do nonsteroidal anti-inflammatory drugs increase the risk of atrial fibrillation after non-cardiac surgery? Insights from translational and clinical research

TL;DR

This paper reviews whether NSAIDs, used for pain after surgery, might increase the risk of heart rhythm problems like atrial fibrillation.

Contribution

It synthesizes preclinical, translational, and clinical evidence to clarify the cardiovascular risks of NSAIDs in postoperative patients.

Findings

NSAIDs may increase the risk of postoperative atrial fibrillation through multiple biological pathways.

Clinicians must balance pain control with cardiovascular safety when using NSAIDs after non-cardiac surgery.

Mechanistic insights include cyclooxygenase inhibition and autonomic dysregulation linked to atrial fibrillation.

Abstract

Non-steroidal anti-inflammatory drugs (NSAIDs) are integral to multimodal analgesic strategies after non-cardiac surgery, aimed at minimizing opioid exposure. Although their analgesic and anti-inflammatory efficacy is well established, emerging evidence raises concerns that perioperative NSAID use may increase the risk of postoperative atrial fibrillation (POAF). Mechanistic studies suggest multiple pathways for this association, including cyclooxygenase inhibition, renin–angiotensin–aldosterone system activation, oxidative stress, and autonomic dysregulation. In this context, perioperative clinicians face the challenge of optimizing pain control while mitigating cardiovascular risk. This review synthesizes preclinical, translational, and clinical data to delineate the potential impact of NSAIDs on POAF risk after non-cardiac surgery, providing a framework for evidence-informed perioperative management.

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