Atrial fibrillation and the prothrombotic state: revisiting Virchow's triad in 2020.

Heart
Wern Yew DingGregory Y H Lip

Abstract

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 str...Continue Reading

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Citations

Jan 24, 2021·Cardiovascular Research·Wern Yew DingGregory Y H Lip
May 16, 2021·Heart·Dhiraj Gupta, Wern Yew Ding
Jun 4, 2021·Stroke; a Journal of Cerebral Circulation·Dearbhla M KellyManish M Sood
Jun 22, 2021·Frontiers in Cardiovascular Medicine·Guido Ascione, Paolo Denti
Jul 1, 2021·British Journal of Clinical Pharmacology·Wern Yew DingGregory Y H Lip
Jul 13, 2021·Cardiology Clinics·Agnieszka KotalczykGregory Y H Lip
Oct 22, 2021·Journal of Cardiovascular Electrophysiology·Nicholas BlackGwilym Morris

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