Atrial fibrillation and venous thromboembolism: evidence of bidirectionality in the Atherosclerosis Risk in Communities Study

Abstract

Background Atrial fibrillation (AF) and venous thromboembolism (VTE) frequently co-occur. These conditions have shared risk factors and are accompanied by coagulation abnormalities. Furthermore, mechanistic pathways may directly link the disorders. Objectives To test the hypothesis that individuals with incident AF are at greater risk of developing VTE, and those with VTE are at elevated risk of AF. We also tested whether associations were stronger in the first 6 months after the initial diagnosis, and explored race differences. Patients/Methods A total of 15 129 ARIC study participants (45-64 years, 55% female, 26% Black) were followed from 1987 to 2011 for incident AF and VTE (median follow-up 19.8 years). Multivariable-adjusted Cox regression was used, with AF and VTE modeled as time-dependent exposures. Results Incident AF was associated with greater risk of subsequent incident VTE (hazard ratio [95% CI], 1.71 [1.32-2.22]); the association was stronger in Black people (2.30 [1.48-3.58]) and during the first 6 months after AF diagnosis (5.08 [3.08-8.38]). Similarly, incident VTE was associated with increased risk of incident AF (1.73 [1.34-2.24]), especially in Black people (2.40 [1.55-3.74]) and in the first 6 months after VTE diagnosis (4.50 [2.61-7.77]). Conclusions The occurrence of AF was associated with increased risk of incident VTE, and occurrence of VTE was associated with greater risk of incident AF. Associations were particularly strong among Black people and during the first 6 months after the initial diagnosis, although they remained elevated even after 6 months. These findings highlight patient populations that may be at increased risk of AF and VTE, and perhaps should be targeted with preventive strategies.

Atrial Fibrillation in Patients with Acute Pulmonary Embolism: Clinical Significance and Impact on Prognosis

“…The presence of AF in patients with PE may be both the cause and the consequence of PE. A bidirectional association between AF and PE was reported previously [5]. Moreover, patients with AF and PE appear to have worse clinical condition as well as higher in-hospital and long-term mortality [6].…”

Identifying mutation‐driven changes in gene functionality that lead to venous thromboembolism

“…Similarly TF are over-expressed in AF patients with thromboembolism (Watson, Shantsila, & Lip, 2009). This observation may explain why an anticoagulative drug warfarin is effective in preventing blood clots in both VTE and AF, as well as why studies found that the two diseases often co-occur and that the presence of one increases the risk for another (Enga et al, 2015; Lutsey et al, 2018; Sundboll et al, 2017). …”

Resting heart rate and incident venous thromboembolism: the Multi-Ethnic Study of Atherosclerosis

“…Venous thromboembolism (VTE) may present as a deep venous thrombosis (DVT) and/or a pulmonary embolism (PE)1 and is associated with significant morbidity and mortality 2 3. Although both diseases (PE and DVT) have different clinical manifestations, they represent the same disease process and share similar risk factors 4 5. The identification of modifiable risk factors is paramount to reducing the disease incidence and prevalence 1.…”