From the Guidelines
Yes, atrial fibrillation (AFib) can cause arterial clots, and the risk of ischemic stroke in AF is increased five-fold, making stroke prevention a major focus of AFib treatment. When the heart's atria fibrillate or quiver instead of contracting effectively, blood can pool and form clots, particularly in an area called the left atrial appendage. These clots can then break loose and travel through the bloodstream to the brain, causing a stroke, or to other arteries in the body, causing various types of arterial embolism. According to the 2024 ESC guidelines for the management of atrial fibrillation 1, the default approach should be to provide oral anticoagulation (OAC) to all eligible patients, except those at low risk of incident stroke or thromboembolism.
The effectiveness of OAC to prevent ischemic stroke in patients with AF is well established 1. Antiplatelet drugs alone (aspirin, or aspirin in combination with clopidogrel) are not recommended for stroke prevention in AF 1. The selection of an anticoagulant agent should be based on shared decision-making that takes into account risk factors, cost, tolerability, patient preference, potential for drug interactions, and other clinical characteristics, including time in the INR therapeutic range if the patient has been on warfarin, irrespective of whether the AF pattern is paroxysmal, persistent, or permanent 1.
Some key factors that increase the risk of clot formation in AFib include:
- Advanced age
- High blood pressure
- Diabetes
- Previous stroke
- Heart failure The risk of clot formation in AFib can be assessed using scoring systems like CHA₂DS₂-VASc, which takes into account these risk factors and others, such as vascular disease and sex category 1. Anticoagulation therapy is often recommended regardless of how frequently AFib episodes occur, as even patients with paroxysmal (intermittent) AFib face an increased risk of stroke.
From the FDA Drug Label
People with atrial fibrillation (a type of irregular heart beat) that is not caused by a heart valve problem (non-valvular) are at an increased risk of forming a blood clot in the heart, which can travel to the brain, causing a stroke, or to other parts of the body.
Yes, Afib can cause arterial clot. Atrial fibrillation increases the risk of forming a blood clot in the heart, which can travel to the brain or other parts of the body, causing a stroke or other complications. 2
From the Research
Afib and Arterial Clot Formation
- Atrial fibrillation (Afib) is a type of irregular heartbeat that can increase the risk of blood clot formation, including arterial clots 3, 4, 5, 6, 7.
- The formation of arterial clots in Afib patients can lead to serious complications, such as stroke and systemic embolism 3, 4, 5, 6, 7.
Role of Anticoagulants in Preventing Arterial Clots
- Anticoagulants, such as warfarin, apixaban, and rivaroxaban, are commonly used to prevent blood clot formation in Afib patients 3, 4, 5, 6, 7.
- These medications work by inhibiting the production of clotting factors in the blood, thereby reducing the risk of arterial clot formation 3, 4, 5, 6, 7.
- Studies have shown that apixaban and rivaroxaban may be more effective than warfarin in preventing stroke and systemic embolism in Afib patients, with a lower risk of bleeding complications 3, 4, 5, 6, 7.
Comparison of Anticoagulants in Afib Patients
- A study published in 2017 found that apixaban, dabigatran, and rivaroxaban were more effective than warfarin in preventing stroke and systemic embolism in Afib patients, with a lower risk of bleeding complications 3.
- Another study published in 2020 found that apixaban had a lower risk of bleeding complications compared to rivaroxaban in Afib patients with polypharmacy 4.
- A systematic review and meta-analysis published in 2021 found that apixaban had a lower risk of major bleeding events compared to warfarin in Afib patients with end-stage renal disease 5.
- A cohort study published in 2020 found that apixaban had a lower risk of ischemic stroke and bleeding complications compared to rivaroxaban in Afib patients in routine practice 6.
- A nationwide US cohort study published in 2024 found that apixaban had a superior safety profile compared to warfarin and rivaroxaban in Afib patients with advanced chronic kidney disease 7.