risk factors for thromboembolism associated with atrial fibrillation
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Etiology
- previous stroke or TIA*
- moderate-severe LV dysfunction (heart failure)
- hypertension*
- age > 75 years*
- diabetes mellitus*
- mitral stenosis
- prosthetic heart valve
- thyrotoxicosis
- coronary artery disease
- renal insufficiency (diminished GFR)[3]
- proteinuria[3]
* strongest predictors of stroke in atrial fibrillation[2]
Pathology
- > 90% of atrial thrombi in patients with non-valvular atrial fibrillation are believed to originate in the left atrial appendage
Management
- see atrial fibrillation
- risk calculators
- CHADS2:
- Congestive heart failure
- Hypertension
- Age >= 75 years,
- Diabetes mellitus
- Stroke
- CHA2DS2VASc
- Congestive heart failure
- Hypertension
- Age >= 75 years
- Age 65 to 74 years
- Diabetes mellitus
- Stroke
- female Sex
- Vascular disease
- Age, Biomarkers, Clinical history (ABC) stroke risk score
- serum N-terminal-pro-B-type natriuretic peptide
- high-sensitivity cardiac troponin I in serum
- age
- prior stroke
- CHADS2:
Notes
- despite comorbidities of diabetes mellitus, proteinuria, & renal insufficiency, irbesartan does not reduce thromboembolism in patients with atrial fibrillation[4]
utility of serum NT-pro-BNP & serum troponin I would seem to question assertion that > 90% of atrial thrombi originate in the left atrial appendage
Additional terms
- ABC (age, biomarkers, clinical history) stroke risk score
- atrial fibrillation (AF)
- CHADS score (CHADS2 score; CHA2DS2-VASc score)
References
- ↑ Ovbiagele B, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
- ↑ Jump up to: 2.0 2.1 Stroke Risk in Atrial Fibrillation Working Group. Independent predictors of stroke in patients with atrial fibrillation: a systematic review. Neurology. 2007 Aug 7;69(6):546-54. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17679673
- ↑ Jump up to: 3.0 3.1 3.2 Go AS et al, Impact of Proteinuria and Glomerular Filtration Rate on Risk of Thromboembolism in Atrial Fibrillation. The Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study Circulation. 2009 Mar 2 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19255343
- ↑ Jump up to: 4.0 4.1 The ACTIVE I Investigators. Irbesartan in patients with atrial fibrillation. N Engl J Med 2011 Mar 10; 364:928. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21388310