Platelets and atrial fibrillation

Atrial brillation is the commonest sustained cardiacrhythm abnormality, leading to substantial mortalityand morbidity from stroke, thromboembolism and heartfailure. Whilst the benets of antithrombotic therapy inpreventing stroke in atrial brillation are increasinglyrecognised, further developments in thromboprophy-laxis are needed, especially since warfarin confers theinconvenience of regular anticoagulation monitoringand the benets of aspirin are inconsistent. An under-standing of the role of platelets in atrial brillation maycontribute to the development of new or combinationantiplatelet agents that may provide a viable alternativeto warfarin for thromboprophylaxis in atrial brillation.Important insights into the pathophysiology ofthrombus formation (thrombogenesis) in atrial bril-lation can be made by reference to the dierent com-ponents of Virchow’s triad for thrombogenesis, that is,abnormal blood ow, abnormal blood constituents andvessel wall abnormalities. Various studies have con-rmed that atrial brillation confers a hypercoagulablestate, with abnormalities of haemostasis and endothelialfunction in this condition, that can be altered by intro-ducing antithrombotic therapy and cardioversion fromatrial brillation to sinus rhythm