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Atrial fibrillation (AF) is well known for left atrial thrombosis and systemic embolism. The similar mechanism may be responsible for right atrial thrombosis and leads to pulmonary embolism (PE) received a little attention. PE is considered as a complication of deep vein thrombosis (DVT). We hypothesized that not only DVT, but also AF mechanism might be responsible for right atrial thrombosis and leads to PE.
We retrospectively analyzed medical records of patients with confirmed diagnosis of PE with AF (Study Group) from 2002-2015. For each PE with AF patient, matched controls (PE without AF) were selected by age and sex in1:2 ratio (Control Group). All demographic and clinical characteristics including potential risk factors for PE were obtained. The CHA2DS2-VASc and CHADS2 scores were classified into 2 categories, low-intermediate (<2 points) and high risk (≥2 points).
In all, 330 patients were included in this study, 110 in Study Group and 220 in Control Group. Among the risk factors of PE, 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) as compared to Control Group. In addition, compared CHADS2, the CHA2DS2-VASc low intermediate risk category had lower [13(11.6%) vs. 49(44.5%), P<0.001] and high risk had higher [97(88.1%) vs. 61(55.4%), P< 0.001] proportion of patients in Study Group.
The much lower incidence of deep vein thrombosis in Study Group suggested that there might be an origin for clots in the right heart particularly appendage and link to proceeding risk factor for pulmonary embolism. In addition, CHA2DS2-VASc scoring system might be more sensitive for prediction and stratification of the PE in AF patients.