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

: 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.