Fibrillation auriculaire et coagulation

Potential complications of atrial fibrillation (AF) include arterial embolism. Oral anticoagulation reduces the occurrence of such events by 62%. Risk stratification can be performed using clinical, transthoracic and transesophagal echocardiography. We performed a review of clinical trials which demonstrated a correlation between AF and hemostasis overexpression, as shown by abnormal coagulation, platelet and endothelial testing. This overexpression is independant of the cause of AF or the underlying structural heart disease and correlated with clinical and echocardiographic risk markers in prethrombic and thrombotic situations. It is reduced by appropriate antithrombotic therapy or cardioversion. No marker is an independant predictor: in the SPAF trial, plasma von Willebrand factor was predictive of stroke by univariate analysis, but not after adjusting for other risk factors. The many pathophysiological and clinical interactions between AF, atherosclerosis and hypertension could suggest the hypothesis of a general endothelial disorder, implying thrombotic and inflammatory mechanisms.