Early recurrent embolism associated with nonvalvular atrial fibrillation: a retrospective study

Nonvalvular atrial fibrillation (NVAF) can be a source of cardiogenic brain embolism. We retrospectively reviewed the clinical features of 56 patients with acute brain infarction and NVAF. Based on clinical criteria, 35 infarcts (63%) were classified as probably embolic, 13 infarcts (23%) as probably nonembolic and 8 infarcts (14%) as of indeterminate pathogenesis. Among the 35 patients with presumed embolic infarcts, 12 patients were immediately anticoagulated without hemorrhagic complications. Of 23 patients who did not receive immediate anticoagulation, three (13%) experienced recurrent embolism (one each to brain, kidney and leg) within 10 days of initial embolism. There were no early recurrent emboli in patients receiving immediate anticoagulation or patients in the nonembolic or indeterminate category. Five additional patients experienced probable brain or systemic emboli within the 11 days prior to the marker stroke event. Including these patients, 20% (8 of 40) of all NVAF patients who were not immediately anticoagulated experienced recurrent embolism within 11 days of the initial embolus. Early recurrent emboli are common in NVAF patients who experience embolic stroke.