Atrial fibrillation: thromboembolic risk and indications for anticoagulation

Article Abstract:

Atrial fibrillation is a common cardiac arrhythmia. It is associated with an increased risk of thromboembolism, in which a clot dislodges, travels through the bloodstream, and eventually is deposited, blocking off blood flow - usually to the brain. The risk of embolism associated with rheumatic heart disease affecting the valves is high, and is further increased when atrial fibrillation is present. The use of anticoagulant therapy can decrease the risk of embolic stroke in these patients; however, there are various viewpoints on the use of anticoagulants in patients with atrial fibrillation. A critical review of the medical literature and newly available data has led to recommendations for anticoagulation in most patients with atrial fibrillation. The overall risk of bleeding from anticoagulation therapy is approximated at 11 to 40 percent. Major bleeding may occur in the gastrointestinal, genitourinary, vaginal, respiratory, or retroperitoneal systems. The ultimate safety of anticoagulation, however, depends on the underlying cause of the atrial fibrillation. To monitor anticoagulation therapy, frequent medical visits and laboratory tests are needed. The physician must weigh the risks and benefits of anticoagulation for each patient. Anticoagulation is clearly beneficial in reducing the risk of embolism during cardioversion (induced electrical countershock) of patients with atrial fibrillation. Therapy should be instituted three weeks before the cardioversion and continue for four weeks afterwards. Other strong indicators for anticoagulation are atrial fibrillation associated with valvular disease or history of a previous embolism. Nevertheless, each patient must be assessed individually. Contraindications to anticoagulation must be examined and the benefits and risks must be critically evaluated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Stroke (Disease), Stroke

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Risk factors for thromboembolic complications in chronic atrial fibrillation

Article Abstract:

Atrial fibrillation (AF) is extremely rapid, incomplete contractions of the atria resulting in fine, irregular, and uncoordinated movements. This type of arrhythmia or abnormal heart rhythm is associated with a high risk of developing thromboembolism, the blockage of a blood vessel by a mobile blood clot. The anticoagulant warfarin (coumadin) reduces the incidence of thromboembolism in patients with AF, but has been associated with a high risk of bleeding. Thus, it is important to identify the risk factors for AF-related thromboembolism in order to select those patients who would benefit most from anticoagulant treatment. This study included 1,007 patients with chronic AF. A physical examination, chest X-ray, and echocardiography (the use of sound waves to visualize the size of the left atrium) were performed on all patients. The effects of drug treatment on the development of thromboembolism were not included in this report; instead, it focused on examining the incidence of thromboembolism in the 336 AF patients who received a placebo, or inactive substance. The results revealed that previous myocardial infarction, or the deterioration of the heart muscle due to cessation of blood supply, was an important risk factor for developing thromboembolism in AF. The incidence of thromboembolism in AF was not affected by age, sex, heart failure, chest pain, heart disease associated with high blood pressure, smoking, volume of the heart, and size of the left atrium. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Heart attack

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Physician variation in anticoagulating patients with atrial fibrillation

Article Abstract:

Atrial fibrillation, an abnormal heart rhythm originating in the atrium of the heart, occurs in many diseases. Patients with atrial fibrillation and patients with heart valve disease are at a higher risk for developing embolism, in which clots form, dislodge, and become deposited and block blood flow. Patients with atrial fibrillation can be given anticoagulation agents drugs to prevent blood clots. There is no clear consensus whether the benefits of anticoagulation therapy outweigh the risk of hemorrhage, a side effect of these drugs. Physicians were questioned to see whether decisions regarding anticoagulation therapy in five hypothetical patients were based on their estimates of risk. Three types of subspecialists were questioned, namely family physicians (general practitioners), general internists and cardiologists. The three groups were in agreement regarding treatment of patients with heart valve disease because of the obvious high risk of embolism in that group. They also agreed not to treat alcoholics with anticoagulants because of the increased risk for hemorrhage. Cardiologists rated the risk of embolism lower than the other two specialists and were least likely to give anticoagulation therapy to patients having nonvalve disease with atrial fibrillation. Family practitioners were more inclined to treat nonvalve disease atrial fibrillation with anticoagulants. There was a strong relationship between type of physician and estimate of risk. (Consumer Summary produced by Reliance Medical Information, Inc.)

Prevention, Embolism, Hemorrhage

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