Management of thromboembolism in atrial fibrillation

Abstract

Context: Atrial fibrillation is the most common sustained arrhythmia, increases with age, and presents with highly variable symptoms and severity. Paroxysmal, persistent, and permanent form require very individualized approaches to management. The most important aspect of diagnosis is the risk groups and risk stratification with respect to risk of thromboembolism. The general goals in treatment are, in order of importance: Prevention of thromboembolism, control of ventricular response, restoration of sinus rhythm, and maintenance of sinus rhythm by preventing recurrence. Objective: To assess risk groups and risk of thromboembolism of AF patients. Patient and method: 150 patients were included in this study all have permanent AF. The final diagnosis was based on careful evaluation of clinical data and the results of various investigations, all were studied by history, examination, ECG, radiology, echocardiography and biochemical tests when indicated, ischemic heart disease was diagnosed by the history of chest pain typical of chest pain of myocardial ischemia and electrocardiographic criteria of myocardial ischemia, risk groups for thromboembolism in AF and indication for anticoagulation were determined.Results: The high risk group patients was the highest in the prevalence among risk groups patients (40.7%), followed by moderate risk group (32.7%), then the very high risk group patients (22%), lastly the low risk group patients (4.6%). There was under prescription of warfarin in very high and high risk groups so that in very high risk group the indicated patients were (22%) and the non-treated patients were (78.8%) (p=0.035). In high risk group patients the indicated patients for warfarin were (40.7%) and the non-treated patients were (80%) (p=0.003). In moderate risk group patients the indicated for treatment were (61.2%) (p=