Is Atrial Fibrillation a Prognosticator in Acute Pulmonary Thromboembolism?

Koraćević, Goran; Atanaskovic, V.

doi:10.1159/000273082

Cited by 16 publications

(19 citation statements)

References 5 publications

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“…In our study the presence of atrial fibrillation alone showed no association with mortality from PE, confirming some other reports [6], but in contrast to the findings of other authors [7][8][9].…”

supporting

confidence: 88%

A retrospective cohort study of patients with pulmonary embolism: the impact of comorbidities on patient's outcome

Mameli¹,

Palmas²,

Antonelli³

et al. 2016

Eur Respir J

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supporting

confidence: 88%

A retrospective cohort study of patients with pulmonary embolism: the impact of comorbidities on patient's outcome

Mameli¹,

Palmas²,

Antonelli³

et al. 2016

Eur Respir J

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“…Specifically, we identified nine studies that reported the prognostic significance of coexisting AF in patients with PE, the majority of which (all but one) hinted at the prognostic significance of coexisting AF on clinical outcomes (►Table 3). 37,53,54,56,58,59,[93][94][95] Finally, a recent systematic review of the literature on the significance of electrocardiographic findings in patients with PE, which was only partially inclusive of the studies discussed here, indicated that the presence of AF is associated with increased risk of circulatory shock and death. 96 Abbreviations: AF, atrial fibrillation; CI, confidence interval; CT, computed tomography; DVT, deep vein thrombosis; PE, pulmonary embolism; VTE, venous thromboembolism.…”

Section: Prognostic Significancementioning

confidence: 86%

Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review

Bikdeli

Ziki

Lip

2017

Semin Thromb Hemost

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Pulmonary embolism (PE) is a common, potentially fatal thrombotic disease. Atrial fibrillation (AF), the most common arrhythmia, may also lead to thromboembolic complications. Although initially appearing as distinct entities, PE and AF may coexist. The direction and extent of this association has not been well characterized. We performed a search of PubMed, Scopus, and the Cochrane Database of Systematic Reviews for publications that reported coexisting AF in patients with PE, or vice versa, to provide a systematic overview of pathophysiological and epidemiological aspects of this association (last search: October 13, 2016). We screened 650 articles following the PubMed search, and 697 through Scopus. PE and AF share many common risk factors, including old age, obesity, heart failure, and inflammatory states. In addition, PE may lead to AF through right-sided pressure overload or inflammatory cytokines. AF, in turn, might lead to right atrial appendage clot formation and thereby PE. Epidemiological studies indicate that AF can be seen as a presenting sign, during the early phase, or later in the course of recovery from PE. Patients with AF are also at increased risk of developing PE, a risk that correlates with the CHADS-VASc score. For the choice of antithrombotic therapy, PE-related factors (provoked or unproved, active cancer, and prior recurrence) and AF-related factors (CHADS-VASc score), risk of bleeding, and patient preferences should be considered. In conclusion, PE and AF may coexist, with an understudied bidirectional association. Prognostication and choice of antithrombotic therapy in patients with both PE and AF might be different compared with those who present with only one of the two and warrants further investigation.

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“…The prevalence of atrial fibrillation in the general population is reported to be 2–3% , whereas the reported prevalence of atrial fibrillation ranges from 15 to 21% in patients with acute pulmonary embolism . Despite this relatively frequent co‐existence of pulmonary embolism and atrial fibrillation, the relationship between the two conditions has not been extensively investigated in prospective observational studies.…”

Section: Introductionmentioning

confidence: 99%

Atrial fibrillation and future risk of venous thromboembolism:the Tromsø study

Enga

Rye-Holmboe

Hald

et al. 2015

Journal of Thrombosis and Haemostasis

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Summary. Aims: Whether atrial fibrillation is related to risk of venous thromboembolism (VTE) has not been extensively studied. Therefore, we investigated the association between atrial fibrillation and future risk of VTE in a population-based cohort. Methods: In total, 29 975 subjects were recruited from three surveys of the Tromsø study and followed from enrollment (1994-1995, 2001-2002 and 2007-2008) up to 2010. Incident events of atrial fibrillation and VTE during follow-up were recorded. Information on potential confounders was obtained at baseline. Cox-regression models with atrial fibrillation as time-dependent variable were used to calculate hazard ratios (HRs) for VTE with 95% confidence intervals (CIs). Results: During 16 years of median follow-up, 1604 subjects were diagnosed with atrial fibrillation and 614 with incident VTE. The risk of VTE was substantially increased during the first 6 months after diagnosis of atrial fibrillation (HR, 8.44; 95% CI, 5.61-12.69), and remained increased throughout the study period (HR, 1.43; 95% CI, 1.43-1.99) compared with those without atrial fibrillation. Atrial fibrillation displayed higher risk estimates for pulmonary embolism (HR, 11.84; 95% CI,) than for deep vein thrombosis (HR, 6.20; 95% CI,) during the first 6 months, and was still associated with pulmonary embolism (HR, 1.96; 95% CI, 1.24-3.10) but not with deep vein thrombosis (HR, 1.08; 95% CI, 0.66-1.75) more than 6 months after diagnosis. Conclusion: Atrial fibrillation was associated with increased risk of VTE, and pulmonary embolism in particular. Our findings support the concept that isolated pulmonary embolism may originate from right atrial thrombi due to atrial fibrillation.

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Is Atrial Fibrillation a Prognosticator in Acute Pulmonary Thromboembolism?

Cited by 16 publications

References 5 publications

A retrospective cohort study of patients with pulmonary embolism: the impact of comorbidities on patient's outcome

A retrospective cohort study of patients with pulmonary embolism: the impact of comorbidities on patient's outcome

Pulmonary Embolism and Atrial Fibrillation: Two Sides of the Same Coin? A Systematic Review

Atrial fibrillation and future risk of venous thromboembolism:the Tromsø study

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