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

Ding, Wern Yew ORCID: 0000-0003-3596-6545, Gupta, Dhiraj and Lip, Gregory YH ORCID: 0000-0002-7566-1626 (2020) Atrial fibrillation and the prothrombotic state: revisiting Virchow's triad in 2020. HEART, 106 (19). pp. 1463-1468.

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Official URL: http://dx.doi.org/10.1136/heartjnl-2020-316977

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 stratification and targeted therapies in AF.

Item Type:	Article
Uncontrolled Keywords:	Blood Vessels, Animals, Humans, Atrial Fibrillation, Thrombosis, Prognosis, Risk Assessment, Risk Factors, Comorbidity, Blood Coagulation, Fibrinolysis, Platelet Activation, Models, Cardiovascular, Hemodynamics
Depositing User:	Symplectic Admin
Date Deposited:	13 Oct 2020 09:43
Last Modified:	18 Jan 2023 23:28
DOI:	10.1136/heartjnl-2020-316977
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3104069