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[Atrial fibrillation and thromboembolism: a multicenter cooperative study. Research Group for Antiarrhythmic Drug
Insights
The annual risk of thromboembolism in atrial fibrillation patients is low, particularly for those without heart disease. Antiplatelet therapy appears beneficial in reducing this risk.
Area of Science:
- Cardiology
- Thrombosis Research
- Epidemiology
Context:
- Atrial fibrillation (AF) poses a significant risk for thromboembolic events.
- Understanding AF-related thromboembolism prevalence and risk factors is crucial for effective primary prevention.
Purpose:
- To determine the prevalence of thromboembolism in Japanese AF patients.
- To identify risk factors for thromboembolism in AF.
- To evaluate the efficacy of antiplatelet therapies in AF patients.
Summary:
- This multicenter, retrospective study analyzed 1,819 Japanese AF patients over 4.6 years.
- The annual thromboembolism rate was 1.9%, significantly lower (0.9%) in patients without underlying heart disease.
- Hypertension, sick sinus syndrome, and left ventricular dysfunction were identified as risk factors. Antiplatelet treatments (aspirin, warfarin, ticlopidine) showed potential benefit.
Impact:
- Findings suggest a low embolism risk in AF patients, with antiplatelet therapy showing promise.
- Identifies key risk factors, aiding in targeted prevention strategies for AF-related thromboembolism.
- Highlights the importance of considering underlying heart disease in AF thromboembolism risk assessment.
Abstract:
A multicenter, retrospective study was undertaken to determine the prevalence of and risk factors for thromboembolism and efficacy of therapy in patients with atrial fibrillation. The primary prevention group consisted of 1,819 Japanese patients (mean age 64 years). During the mean follow-up period of 4.6 years. 158 patients developed cerebral thromboembolism or peripheral embolism (1.9%/year). The annual rate of thromboembolic complications was 0.9% for patients without underlying heart disease which was significantly lower compared with that for patients with underlying heart disease (p < 0.001). The annual rate was 1.4% among patients treated with aspirin (alone and in combination with other drugs except for warfarin), 1.4% with warfarin (alone and in combination with other drugs) and 1.1% with ticlopidine. The risk was lower for patients receiving these drugs (2.2%/year, p < 0.001). Among 801 patients not receiving treatment for thromboembolism, the annual rate was 0.9% for patients without underlying heart disease, which was significantly lower compared with patients with underlying heart diseases (e.g., 2.5% for ischemic heart disease and 2.1% for mitral valve disease, p < 0.001). Multivariate analysis using quantification method II revealed hypertension, sick sinus syndrome and left ventricular dysfunction (> or = NYHA class II) as risk factors for embolism. Although limited due to its retrospective nature, the present study suggests that the risk for embolism seems low in patients with atrial fibrillation but is not associated with underlying heart diseases or other risk factors, and antiplatelet treatment seems beneficial for these patients.