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risk factors for thromboembolism associated with atrial fibrillation

Etiology: 1) previous stroke or TIA* 2) moderate-severe LV dysfunction (heart failure) 3) hypertension* 4) age > 75 years* 5) diabetes mellitus* 6) mitral stenosis 7) prosthetic heart valve 8) thyrotoxicosis 9) coronary artery disease 10) renal insufficiency (diminished GFR) [3] 11) 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 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

Related

ABC (age, biomarkers, clinical history) stroke risk score atrial fibrillation (AF) CHADS score (CHADS2 score; CHA2DS2-VASc score)

References

  1. Ovbiagele B, In: Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 29-Oct 2, 2004
  2. 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: 17679673
  3. 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: 19255343
  4. The ACTIVE I Investigators. Irbesartan in patients with atrial fibrillation. N Engl J Med 2011 Mar 10; 364:928. PMID: 21388310