Original Article

Atrial fibrillation is related to lower incidence of deep venous thrombosis in patients with pulmonary embolism

Khalid Bin Waleed, Xumin Guan, Xintao Li, Yiheng Yang, Zhao Wang, Xiaomeng Yin, Zhengyan Wang, Jianghai Liu, Lianjun Gao, Dong Chang, Xianjie Xiao, Rongfeng Zhang, Gary Tse, Yunlong Xia


Background: Atrial fibrillation (AF) is an established risk factor of left atrial thrombosis and systemic embolism. Traditionally pulmonary embolism (PE) is a recognized complication of deep vein thrombosis (DVT). However, whether AF is responsible for right atrial thrombosis and leads to PE has not been examined.
Methods: We retrospectively analyzed medical records of patients with confirmed diagnosis of PE with AF (study group) from 2002–2015. Patients with PE without AF, matched by age and sex, served as controls (control group). The CHA2DS2-VASc and CHADS2 scores were classified into two categories, lowintermediate (<2 points) and high-risk (≥2 points).
Results: A total of 330 patients (110 in study group and 220 in control group). The study group had significantly lower incidence of newly diagnosed DVT (21% vs. 44%, P<0.001), previous history of DVT (6% vs. 17%, P=0.006) and recent surgery or trauma (10% vs. 23%, P=0.004) compared to the control group. When stratified by the CHADS2 score, 49 patients (44.5%) were considered low-intermediate risk. This proportion significantly differed when stratified using CHA2DS2-VASc, in which 13 patients (13.6%) were considered low-intermediate risk, P<0.001.
Conclusions: The incidence of DVT was much lower in the study group, suggesting the possibility of clots originated from the right heart that may increase the risk of PE. The CHA2DS2-VASc scoring system might be more sensitive for prediction and stratification of the PE in AF patients than the CHADS2 score.

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