In a recent systematic review and meta-analysis published in the Journal of the American College of Cardiology: Advances, researchers sought to explore the risk of venous thromboembolism (VTE) among patients with atrial fibrillation (AF) from the time since AF diagnosis.
The authors indicated that data on the correlation between AF and VTE are controversial.
The authors wrote, “It is therefore arguable that AF may be associated with an increased risk of VTE, but divergent data on this topic have been published. Our aim was to investigate by a systematic review and meta-analysis of observational studies the risk of VTE in patients with AF, by analyzing the overall risk of VTE either PE [pulmonary embolism] or DVT [deep vein thrombosis] according to the time from AF diagnosis (i.e., 3, 6, or >6 months).”
The Searches Strategy and Study Selection were conducted from December 1, 2021, to January 31, 2022. The systematic review included MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature (EBSCO host), Cochrane Central Register of Controlled Trials (2020) in the Cochrane Library, World Health Organization Global Index Medicus databases, and meta-analysis of observational studies.
The risk of VTE, DVT, and PE was evaluated according to the time of AF onset: 1) short (≤3 months); 2) medium (≤6 months); and 3) long (>6 months) time groups.
The researchers found eight studies that involved 4,170,027 patients, of whom 650,828 were diagnosed with AF.
The authors noted, “In the short-term group, AF was associated with the highest risk of either PE (HR: 9.62; 95% CI: 7.07-13.09; I2 = 0%) or DVT (HR: 6.18; 95% CI: 4.51-8.49, I2 = 0%). Even if to a lesser extent, AF was associated with a higher risk of VTE (HR: 3.69; 95% CI: 1.65-8.27; I2 = 79%), DVT (HR: 1.75; 95% CI: 1.43-2.14; I2 = 0%), and PE (HR: 4.3; 95% CI: 1.61-11.47; I2 = 68%) in the up-to-6 months and long-term risk group >6 months groups (HR: 1.39; 95% CI: 1.00-1.92; I2 = 72%) and PE (HR: 1.08; 95% CI: 1.00-1.16; I2 = 0%).”
The authors indicated that the meta-analysis of observational studies offers evidence that the risk of VTE is greatest in the first 3 months after AF diagnosis and declines over time, although the risk remains in studies with long-follow-up over 6 months.
The authors wrote, “Indeed, we found a 6- to 9-fold increase in the risk of DVT or PE in the short-term period.”
Based on their findings, the authors concluded that in the first 3 to 6 months after AF diagnosis, the risk of VTE is highest and diminishes over time, and the early initiation of anticoagulation therapy in patients with AF may decrease not only the risk of thromboembolic stroke/systemic embolism but also the risk of VTE.
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