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Left Atrial Thrombus Despite Anticoagulation: The Importance Of Homocysteine

J David Spence1

  • 1Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University.

Journal of Atrial Fibrillation
|May 13, 2017
PubMed

Patients in atrial fibrillation may have left atrial thrombi or strokes despite adequate anticoagulation. It is important to consider elevated plasma total homocysteine (tHcy) as a treatable clotting factor that may explain such cases. Metabolic B12 deficiency is common even in patients with a "normal" serum B12. Measurement of holotranscobalamin, methylmalonic acid or, in folate-replete patients, tHcy are necessary to diagnose metabolic B12 deficiency when the serum B12 is below 400 pmol/L. Elevated tHcy quadruples the risk of stroke in atrial fibrillation, and is far more common than the usual clotting factors for which testing is commonly performed: among patients attending.

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