Atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary emboli in stroke patients.

Noël, Philippe; Grégoire, Françoise; Capon, A; Lehert, Philippe

doi:10.1161/01.str.22.6.760

Cited by 42 publications

(37 citation statements)

References 11 publications

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“…Binary variables for each of these factors were included as timedependent variables in the model. Because atrial fibrillation might trigger thrombosis formation, increasing the risk of stroke, myocardial infarction, and arterial emboli, as well as being associated with risk of venous thromboembolism independently 17 or in association with concomitant stroke, 18 we additionally included atrial fibrillation in the comorbidity-adjusted model. Wald tests were used to compute 95% confidence intervals (CI).…”

Section: Discussionmentioning

confidence: 99%

ABO Blood Group and Risk of Thromboembolic and Arterial Disease

et al. 2016

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T he clinical importance of ABO blood groups extends beyond the direct implications on transfusion and organ-transplantation compatibility. It is increasingly being recognized that individuals with non-O blood groups may be at elevated risk of venous thromboembolic events (VTEs), myocardial infarction, cerebrovascular ischemic events, and peripheral vascular disease compared with individuals with blood group O.1-4 This risk increase has been attributed to higher concentrations of factor VIII and von Willebrand factor. 5,6 Approximately 70% of the variation in the levels of these factors is genetically determined, and 30% of the explained variation is attributable to ABO blood groups. 7 In addition, Sode and colleagues 8 have shown that ABO blood type has an additive effect on the risk of VTE when combined with factor V Leiden R506Q and prothrombin G20210A mutations. A recent genome-wide association study has identified variants in the ABO locus that are associated with VTE, 9 providing additional clues to the genetic influence on thromboembolic risk. Available epidemiological data, however, fail to provide a coherent picture of the association between ABO blood group and thromboembolic risk. First, there is a Background-ABO blood groups have been shown to be associated with increased risks of venous thromboembolic and arterial disease. However, the reported magnitude of this association is inconsistent and is based on evidence from smallscale studies. Methods and Results-We used the SCANDAT2 (Scandinavian Donations and Transfusions) database of blood donors linked with other nationwide health data registers to investigate the association between ABO blood groups and the incidence of first and recurrent venous thromboembolic and arterial events. Blood donors in Denmark and Sweden between 1987 and 2012 were followed up for diagnosis of thromboembolism and arterial events. Poisson regression models were used to estimate incidence rate ratios as measures of relative risk. A total of 9170 venous and 24 653 arterial events occurred in 1 112 072 individuals during 13.6 million person-years of follow-up. Compared with blood group O, non-O blood groups were associated with higher incidence of both venous and arterial thromboembolic events. The highest rate ratios were observed for pregnancy-related venous thromboembolism (incidence rate ratio, 2.22; 95% confidence interval, 1.77-2.79), deep vein thrombosis (incidence rate ratio, 1.92; 95% confidence interval, 1.80-2.05), and pulmonary embolism (incidence rate ratio, 1.80; 95% confidence interval, 1.71-1.88). Conclusions-In

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Section: Discussionmentioning

confidence: 99%

ABO Blood Group and Risk of Thromboembolic and Arterial Disease

et al. 2016

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“…1 The risk of DVT correlates with the degree of paralysis 4 and is greater in older patients 5 as well as those who have atrial fibrillation. 6 Predilection for the paralyzed leg is probably explained by a combination of loss of the calf muscle pump and repeated minor trauma. 7 DVT is also present in a significant proportion of patients during the rehabilitation phase of stroke, the risk being greater in those who are more immobile 8 : in a study of 150 patients admitted to a stroke rehabilitation unit at, on average, 9 weeks after stroke, bilateral venography revealed DVT in 33%.…”

Section: Incidence Of Dvt After Strokementioning

confidence: 99%

Venous Thromboembolism After Acute Stroke

Kelly

Rudd

Lewis

et al. 2001

Stroke

220

165

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Background-Treatment for venous thromboembolism (VTE) is highly effective in preventing morbidity and mortality, yet pulmonary embolism (PE) accounts for up to 25% of early deaths after stroke. This is because the current diagnostic paradigm is reactive rather than proactive: the clinician responds to VTE when it becomes symptomatic, in the expectation that initiation of treatment will prevent progression to more serious manifestations. This approach is flawed, because sudden death from PE is frequently unheralded and nonfatal symptomatic pulmonary emboli are often unrecognized or misdiagnosed. Summary of Comment-Morbidity and mortality from PE could be reduced either by more effective thromboprophylaxis or earlier diagnosis and treatment of established VTE. The fact that early use of short-term, low-dose, unfractionated heparin (UFH) is not associated with sustained, clinically meaningful benefit suggests that a fundamental change in the diagnostic approach to VTE is needed, one which requires a greater appreciation that clinically apparent events are merely the tip of the thromboembolism iceberg. Conclusions-Research into a strategy of screening for subclinical VTE in these patients is needed, with a view to identifying a subgroup at risk of progression to symptomatic and life-threatening events, in whom outcome might be improved by anticoagulation. (Stroke. 2001;32:262-267.)

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“…Clinical signs are not always present in legs in which the presence of DVT is established this way [69]. Severe leg weakness [70] and atrial fibrillation [71] are associated with an increased risk of DVT. This complication is feared mainly because of the risk of pulmonary embolism, which occurred in 6 out of 106 control patients in the above-mentioned overview [68], and accounted for 3 and 15% of deaths in two other studies [2, 70].…”

Section: Systemic Complicationsmentioning

confidence: 99%

Complications of Acute Ischaemic Stroke

Worp¹,

Kappelle²

1998

Cerebrovasc Dis

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Neurological, cardiac, and systemic complications during the first days to weeks after ischaemic stroke can cause substantial morbidity and mortality. The reported 30-day case fatality rate for cerebral infarction varies between 10 and 17%. The incidence and effects of the various complications vary with time after stroke: transtentorial herniation and other cerebral complications prevail during the 1st week, whereas medical complications are more prominent in the weeks thereafter. Many complications are treatable, and some are preventable. The goal of this report is to provide information on their incidence, consequences, and management.

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Atrial fibrillation as a risk factor for deep venous thrombosis and pulmonary emboli in stroke patients.

Cited by 42 publications

References 11 publications

ABO Blood Group and Risk of Thromboembolic and Arterial Disease

ABO Blood Group and Risk of Thromboembolic and Arterial Disease

Venous Thromboembolism After Acute Stroke

Complications of Acute Ischaemic Stroke

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