Venous Thromboembolism in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of 4,170,027 Patients

Daniele Pastori; Gianluca Gazzaniga; Alessio Farcomeni; Tommaso Bucci; Danilo Menichelli; Giovanni Franchino; Arianna Pani; Francesco Violi; Pasquale Pignatelli; Laurent Fauchier; Gregory Y H Lip

doi:10.1016/j.jacadv.2023.100555

Venous Thromboembolism in Patients With Atrial Fibrillation: A Systematic Review and Meta-Analysis of 4,170,027 Patients

JACC Adv. 2023 Aug 16;2(7):100555. doi: 10.1016/j.jacadv.2023.100555. eCollection 2023 Sep.

Authors

Daniele Pastori^{1

2}, Gianluca Gazzaniga³, Alessio Farcomeni⁴, Tommaso Bucci^{2

5}, Danilo Menichelli^{1

5}, Giovanni Franchino¹, Arianna Pani³, Francesco Violi^{1

6}, Pasquale Pignatelli^{1

6}, Laurent Fauchier⁷, Gregory Y H Lip²

Affiliations

¹ Department of Clinical, Internal Medicine, Anaesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
² Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
³ Oncology and Hemato-Oncology Department, Università degli Studi di Milano, Milan, Italy.
⁴ Department of Economics and Finance, University of Rome "Tor Vergata", Rome, Italy.
⁵ Department of General Surgery, Surgical Specialties and Organ Transplantation "Paride Stefanini", Sapienza University of Rome, Rome, Italy.
⁶ Mediterranea Cardiocentro, Naples, Italy.
⁷ Service de Cardiologie, Centre Hospitalier Universitaire Trousseau, Tours, France.

Abstract

Background: Data on the association between atrial fibrillation (AF) and venous thromboembolism (VTE) are controversial.

Objectives: The purpose of this study was to investigate the risk of VTE in patients with AF according to the time from AF diagnosis.

Methods: Systematic review of MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature (EBSCO host), Cochrane Central Register of Controlled Trials (2020) in the Cochrane Library, and World Health Organization Global Index Medicus databases and meta-analysis of observational studies. The risk of VTE, deep vein thrombosis (DVT) and pulmonary embolism (PE) was analyzed according to the time of AF onset: 1) short (≤3 months); 2) medium (≤6 months); and 3) long (>6 months) time groups.

Results: Eight studies were included with 4,170,027 patients, of whom 650,828 with AF. 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%).

Conclusions: The risk of VTE is highest in the first 3 to 6 months after AF diagnosis and decreases over time. The early initiation of anticoagulation in patients with AF may reduce the risk of VTE.

Keywords: atrial fibrillation; deep vein thrombosis; pulmonary embolism; venous thromboembolism.