Atrial arrhythmias thromboembolism risk

Recent evidence indicates that many patients with atrial fibrillation—a very common arrhythmia in the elderly—do as well with simple control of ventricular rate as with conversion to normal sinus rhythm. Measures (such as anticoagulant drugs) should be taken to reduce the risk of thromboembolism in chronic atrial fibrillation. 

The increased risk of thromboembolism associated with arrhythmia, primarily atrial fibrillation, and the placement of mechanical heart valves has long been recognized. Similarly, prolonged bed rest, high-risk surgical procedures, and the presence of cancer are clearly associated with an increased incidence of deep venous thrombosis and embolism. 

Atrial fibrillation (Afib) is the most common cardiac arrhythmia in the United States. Persons with Afib are at increased risk of blood clots in the heart that in turn may lead to thromboembolic stroke. The medication warfarin is often prescribed as a preventative measure. While the effectiveness of warfarin in the prevention of thromboembolic stroke is well established, its physiological mechanism of action also puts users at higher risk for other adverse events, for example, bleeding, whose health consequences may be just as devastating. Randomized clinical trials of warfarin have reported favorable results in both effectiveness and safety analyses. However, some clinicians have expressed doubt as to whether these results validly represent the situation in the general Afib patient population. The reason is that typical Afib patients tend to have more comorbidities and may not be as healthy as trial participants. 

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