[Correspondence] Risk of mortality and stroke after atrial fibrillation

Jeff Healey and colleagues1 reported that patients with rheumatic heart disease had a lower risk of stroke compared with patients without the disease, and that when risk factors and age were adjusted, their stroke risks were similar, which is contrary to traditional opinion. However, the order of events between rheumatic heart disease and atrial fibrillation might not have been considered properly in this paper. In patients with atrial fibrillation, stroke is mostly caused by red thrombus, whereas verrucous vegetation causes stroke in rheumatic heart disease; generally speaking, old red thrombus is more likely to fall off and cause stroke.
Source: LANCET - Category: Journals (General) Authors: Tags: Correspondence Source Type: research