We read with interest the article by Frost et al,1 who analyzed the risk of thromboembolism in the aorta and the renal, mesenteric, pelvic, and extremity arteries after discharge from the hospital with a diagnosis of atrial fibrillation (AF).
While we agree wholeheartedly with their emphasis on the need for appropriate thromboembolism prophylaxis in patients with AF, we are concerned that they may have overstated the impact of cardiogenic embolism as a cause of acute peripheral arterial occlusion in patients with AF. For example, they observed that Danish patients discharged from hospitals with a diagnosis of AF have a relative risk of peripheral artery thromboembolisation of 4.0 in men and 5.7 in women compared with the age- and sex-matched population of Denmark as a whole, and the stated risks to the various arteries were 7% in the aorta, 2% in the renal arteries, and 29% in the mesenteric arteries, with the remaining 61% of risk in the upper and lower extremities, although Frost et al were unable to describe the percentage risks in the upper and lower limbs individually.1
Makin AJ, Conway DSG, Lip GYH. Systemic Thromboembolism in Atrial Fibrillation. Arch Intern Med. 2001;161(15):1920-1924. doi: