TY - JOUR
T1 - Atrial fibrillation and the prothrombotic state
T2 - revisiting Virchow's triad in 2020
AU - Ding, Wern Yew
AU - Gupta, Dhiraj
AU - Lip, Gregory Y H
PY - 2020/10
Y1 - 2020/10
N2 - Atrial fibrillation (AF) is characterised by an increased risk of pathological thrombus formation due to a disruption of physiological haemostatic mechanisms that are better understood by reference to Virchow's triad of 'abnormal blood constituents', 'vessel wall abnormalities' and 'abnormal blood flow'. First, there is increased activation of the coagulation cascade, platelet reactivity and impaired fibrinolysis as a result of AF per se, and these processes are amplified with pre-existing comorbidities. Several prothrombotic biomarkers including platelet factor 4, von Willebrand factor, fibrinogen, β-thromboglobulin and D-dimer have been implicated in this process. Second, structural changes such as atrial fibrosis and endothelial dysfunction are linked to the development of AF which promote further atrial remodelling, thereby providing a suitable platform for clot formation and subsequent embolisation. Third, these factors are compounded by the presence of reduced blood flow secondary to dilatation of cardiac chambers and loss of atrial systole which have been confirmed using various imaging techniques. Overall, an improved understanding of the various factors involved in thrombus formation will allow better clinical risk stratification and targeted therapies in AF.
AB - Atrial fibrillation (AF) is characterised by an increased risk of pathological thrombus formation due to a disruption of physiological haemostatic mechanisms that are better understood by reference to Virchow's triad of 'abnormal blood constituents', 'vessel wall abnormalities' and 'abnormal blood flow'. First, there is increased activation of the coagulation cascade, platelet reactivity and impaired fibrinolysis as a result of AF per se, and these processes are amplified with pre-existing comorbidities. Several prothrombotic biomarkers including platelet factor 4, von Willebrand factor, fibrinogen, β-thromboglobulin and D-dimer have been implicated in this process. Second, structural changes such as atrial fibrosis and endothelial dysfunction are linked to the development of AF which promote further atrial remodelling, thereby providing a suitable platform for clot formation and subsequent embolisation. Third, these factors are compounded by the presence of reduced blood flow secondary to dilatation of cardiac chambers and loss of atrial systole which have been confirmed using various imaging techniques. Overall, an improved understanding of the various factors involved in thrombus formation will allow better clinical risk stratification and targeted therapies in AF.
KW - atrial fibrillation
KW - stroke
UR - http://www.scopus.com/inward/record.url?scp=85091126380&partnerID=8YFLogxK
U2 - 10.1136/heartjnl-2020-316977
DO - 10.1136/heartjnl-2020-316977
M3 - Review article
C2 - 32675218
SN - 1355-6037
VL - 106
SP - 1463
EP - 1468
JO - Heart
JF - Heart
IS - 19
ER -