Grant: Project Grant

Of patients requiring cardiac surgery, at least 10% have a history of an abnormal heart rhythm called atrial fibrillation (AF). Atrial fibrillation is also the most frequent complication after cardiac surgery, occurring in up to 60% of patients. Blood thinners prevent stroke in patients with atrial fibrillation and direct oral anticoagulants (DOACs), newer blood thinners that are safer and easier for patients, are generally the treatment of choice. However, small studies suggested that DOACs may be associated with a higher risk of bleeding complications in patients soon after cardiac surgery when compared with another type of blood thinner called vitamin K antagonist (warfarin, Coumadin). The existing evidence to guide doctors in the use of blood thinners after cardiac surgery is limited and of low quality. A large, randomized controlled trial is needed to determine whether DOACs are safe in patients early after cardiac surgery. The Direct Oral Anticoagulation versus Vitamin K Antagonist after Cardiac Surgery (DANCE) trial will randomly (like flipping a coin) assign patients who require a blood thinner after cardiac surgery to either a DOAC or vitamin K antagonist. The DANCE trial will enrol 3500 patients from 50 centres in Canada and abroad to evaluate whether DOACs are noninferior to vitamin K antagonists with regards to major bleeding at 30 days in patients requiring anticoagulation for atrial fibrillation early after cardiac surgery. The results of the DANCE trial will tell us the best blood thinner treatment for patients in the early period after cardiac surgery, improving patient safety.