Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?
View / Open Files
Authors
Hennebry, Eleanor
Hennebry, James
Thakur, Mrinal
Warburton, Elizabeth A
Khadjooi, Kayvan
Publication Date
2022-04Journal Title
Eur J Intern Med
ISSN
0953-6205
Publisher
Elsevier BV
Language
eng
Type
Article
This Version
AM
Metadata
Show full item recordCitation
Induruwa, I., Hennebry, E., Hennebry, J., Thakur, M., Warburton, E. A., & Khadjooi, K. (2022). Sepsis-driven atrial fibrillation and ischaemic stroke. Is there enough evidence to recommend anticoagulation?. Eur J Intern Med https://doi.org/10.1016/j.ejim.2021.10.022
Abstract
Sepsis can lead to cardiac arrhythmias, of which the most common is atrial fibrillation (AF). Sepsis is associated with up to a six-fold higher risk of developing AF, where it occurs most commonly in the first 3 days of hospital admission. In many patients, AF detected during sepsis is the first documented episode of AF, either as an unmasking of sub-clinical AF or as a newly developed arrhythmia. In the short term, sepsis that is complicated by AF leads to longer hospital stays and an increased risk of inpatient mortality. Sepsis-driven AF can also increase an individual's risk of inpatient stroke by nearly 3-fold, compared to sepsis patients without AF. In the long-term, it is estimated that up to 50% of patients have recurrent episodes of AF within 1-year of their episode of sepsis. The common perception that once the precipitating illness is treated or sinus rhythm is restored the risk of stroke is removed is incorrect. For clinicians, there is a paucity of evidence on how to reduce an individual's risk of stroke after developing AF during sepsis, including whether to start anticoagulation. This is pertinent when considering that more patients are surviving episodes of sepsis and are left with post-sepsis sequalae such as AF. This review provides a summary on the literature available surrounding sepsis-driven AF, focusing on AF recurrence and ischaemic stroke risk. Using this, pragmatic advice to clinicians on how to better detect and reduce an individual's stroke risk after developing AF during sepsis is discussed.
Keywords
Anticoagulation, Atrial Fibrillation, Infection, Ischaemic Stroke, Sepsis, Stroke prevention
Sponsorship
British Heart Foundation (None)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Identifiers
External DOI: https://doi.org/10.1016/j.ejim.2021.10.022
This record's URL: https://www.repository.cam.ac.uk/handle/1810/329651
Rights
Attribution-NonCommercial-NoDerivatives 4.0 International
Licence URL: https://creativecommons.org/licenses/by-nc-nd/4.0/
Statistics
Total file downloads (since January 2020). For more information on metrics see the
IRUS guide.