University Hospital, Göttingen, Germany.
Am J Cardiol. 2010 Feb 15;105(4):502-10. doi: 10.1016/j.amjcard.2009.10.018.
Thromboembolism is a severe complication in atrial fibrillation. This overview presents thromboembolic disease as a single entity, ranging from stroke through mesenteric ischemia to acute limb ischemia. The PubMed, Embase, and Cochrane databases were systematically searched for the terms "atrial fibrillation" and "thromboembolism" in reports published from January 1986 to September 2009. The information of 10 evidence-based practice guideline documents and 61 further sources was systematically extracted. In atrial fibrillation, the average annual stroke risk is increased by 2.3% (lethality 30%). The annual incidence of acute mesenteric ischemia is 0.14% (lethality 70%), and that of acute limb ischemia is 0.4% (lethality 16%). In total, approximately 80% of embolism-related deaths are from stroke and 20% from other systemic thromboembolism. The ischemic symptoms generally have an acute onset but may mimic other diseases, particularly in mesenteric ischemia. Early diagnosis and treatment can limit or even prevent tissue infarction. Guideline-recommended therapy with aspirin or warfarin reduces the thromboembolic risk. Suitable patients may optimize their warfarin therapy by self-monitoring of the international normalized ratio (INR). New oral and parenteral anticoagulants with more stable pharmacokinetics are being developed. In conclusion, atrial fibrillation predisposes to thromboembolism. If ischemic stroke or systemic thromboembolism occurs, early diagnosis and treatment can improve outcomes. The thromboembolic risks are reduced by guideline-adherent antithrombotic therapy with warfarin or aspirin. Future directions may include self-monitoring of the international normalized ratio and novel anticoagulants.
血栓栓塞是心房颤动的严重并发症。本篇综述将血栓栓塞性疾病视为一个整体，涵盖了从脑卒中、肠系膜缺血到急性肢体缺血等多种疾病。我们系统性地检索了 1986 年 1 月至 2009 年 9 月期间在 PubMed、Embase 和 Cochrane 数据库中发表的关于“心房颤动”和“血栓栓塞”的文献，使用的检索词为“atrial fibrillation”和“thromboembolism”。我们对 10 篇循证医学实践指南文件和 61 篇其他来源的信息进行了系统性提取。在心房颤动患者中，平均每年发生脑卒中的风险增加 2.3%（致死率 30%）。每年发生急性肠系膜缺血的概率为 0.14%（致死率 70%），急性肢体缺血的概率为 0.4%（致死率 16%）。总的来说，约 80%的栓塞相关性死亡源于脑卒中，20%源于其他系统性血栓栓塞。缺血性症状通常起病急，但可能与其他疾病类似，尤其是在肠系膜缺血时。早期诊断和治疗可以限制甚至预防组织梗死。指南推荐的阿司匹林或华法林治疗可以降低血栓栓塞风险。合适的患者可以通过监测国际标准化比值（INR）实现华法林治疗的自我优化。具有更稳定药代动力学特性的新型口服和胃肠外抗凝剂正在研发中。综上所述，心房颤动易导致血栓栓塞。如果发生缺血性脑卒中或系统性血栓栓塞，早期诊断和治疗可以改善预后。通过华法林或阿司匹林进行的符合指南的抗血栓治疗可以降低血栓栓塞风险。未来的研究方向可能包括 INR 的自我监测和新型抗凝剂。
