From the Guidelines
Coronary thromboembolism is a significant concern in patients with atrial fibrillation, with a frequency of approximately 3-4% per year, as evidenced by studies such as 1 and 1. The frequency of coronary thromboembolism varies based on patient populations studied, with higher rates observed in patients with atrial fibrillation, prosthetic heart valves, and hypercoagulable states.
- Atrial fibrillation increases the risk of stroke by 3- to 4-fold, with approximately 2% to 4% of patients experiencing an ischemic stroke per year, as reported in 1.
- The CHADS2 score is a useful tool for stratifying stroke risk in patients with atrial fibrillation, with higher scores indicating a greater risk of thromboembolism, as shown in 1 and 1.
- Anticoagulation therapy, such as warfarin or direct oral anticoagulants (DOACs), is recommended for patients at high risk of thromboembolism, with a target INR of 2.0-3.0 for warfarin, as suggested in 1 and 1.
- The use of anticoagulation therapy, such as apixaban 5mg twice daily or rivaroxaban 20mg daily, is recommended for patients at high risk of coronary thromboembolism, with antiplatelet therapy with aspirin 81mg daily added for secondary prevention, as supported by 1 and 1. Key factors that increase the risk of coronary thromboembolism include:
- Atrial fibrillation
- Prosthetic heart valves
- Hypercoagulable states, such as protein C or S deficiency, antiphospholipid syndrome, or malignancy
- Age ≥75 years
- History of hypertension, diabetes, coronary artery disease, or prior thromboembolism
- Impaired left ventricular systolic function or heart failure.
From the Research
Frequency of Coronary Thromboembolism
- The frequency of coronary thromboembolism is not directly stated in the provided studies, but it is mentioned that coronary embolism is a rare and potentially fatal phenomenon 2.
- Coronary embolism can occur primarily in patients with valvular heart disease and atrial fibrillation, with the most common causes including infective endocarditis, atrial fibrillation, and prosthetic heart valve thrombosis 2.
- The incidence of coronary embolism is not well-established, but a systematic review of 147 documented cases found that the average age of patients was 54.2 ± 17.6 years, and the mortality rate was 12.9% 2.
Risk Factors and Associations
- Atrial fibrillation is a significant risk factor for coronary thromboembolism, and patients with atrial fibrillation require antithrombotic prophylaxis to prevent stroke and other thromboembolic events 3.
- The use of oral anticoagulation and antiplatelet therapy can increase the risk of bleeding, and the management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention is complex 4, 5.
- The combination of aspirin and warfarin therapy in patients with atrial fibrillation may increase the risk of bleeding with little benefit in decreasing atrial fibrillation-related stroke or cardiovascular events 6.
Treatment and Management
- Treatment strategies for coronary embolism include thrombectomy, thrombolysis, balloon angioplasty, and stent placement, with the goal of rapid restoration of coronary flow 2.
- The management of antithrombotic therapy in patients with atrial fibrillation undergoing percutaneous coronary intervention requires individualized assessment of bleeding and ischemic risks, and the use of non-vitamin K antagonist oral anticoagulants and dual antiplatelet therapy may be recommended 4, 5.