Pulmonary Vascular Disease: Pulmonary Vascular Disease - PE/DVT |

The Yin-Yang of Atrial Fibrillation and Pulmonary Embolism FREE TO VIEW

Maen Abou Ziki, MD; Behnood Bikdeli, MD; Gregory Lip, MD
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Yale University School of Medicine, New Haven, CT

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):1189A. doi:10.1016/j.chest.2016.08.1298
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SESSION TITLE: Pulmonary Vascular Disease - PE/DVT

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 26, 2016 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary embolism (PE) is a common life-threatening thrombotic disease. Atrial fibrillation (AF), the most common arrhythmia may also have devastating thromboembolic complications. Although the two conditions appear as distinct entities, PE and AF may co-occur. The direction and extent of the association between the two has not been well characterized. Our objective was to provide a systematic overview of pathophysiological and epidemiological aspects of the association between PE and AF, and to highlight the significance of their coexistence.

METHODS: We performed a systematic search of PubMed for publications that reported coexisting AF in patients with PE, or vice versa from January 1900 to January 2016. The reference list of relevant articles was hand-searched, as were the large registries of PE, and AF.

RESULTS: We screened 592 articles through the PubMed search and many more through the resultant hand-search. PE and AF share many common risk factors, including old age, obesity, heart failure, and inflammatory states. PE may lead into AF through right-sided pressure overload and contributions from inflammatory cytokines or serotonin. AF might lead to right atrial appendage clot formation and thereby PE. Multiple studies indicate that AF can be seen as a presenting sign, during the early phase, or later in the course of recovery for patients with PE. Patients with AF are also at increased risk of developing PE; a risk that correlates with the CHA2DS2-VASc score. Antithrombotic therapy could be tailored based on presence and risk of both PE and AF.

CONCLUSIONS: PE and AF may coexist and have a bidirectional association, one that is under-recognized and under-studied.

CLINICAL IMPLICATIONS: While further studies are needed to examine this relationship, the 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.

DISCLOSURE: The following authors have nothing to disclose: Maen Abou Ziki, Behnood Bikdeli, Gregory Lip

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