What is the clinical evidence from this study?

Study design: Observational. Population: Atrial fibrillation (n=16). Intervention: Physical activity with portable TCD-X monitoring. Primary outcome: Incidence of micro-embolic signals (MES) during physical activity.

April 1, 2021Open Access

Microembolic signal detection in patients with atrial fibrillation treated with oral anticoagulant

Key Result

Physical activity during 1 hour of portable TCD-X monitoring in AF patients treated with DOACs resulted in a 25% incidence of micro-embolic signals.

Study Design

Type

Observational (n=16)

Structured PICO

Does physical activity increase the incidence of micro-embolic signals in patients with atrial fibrillation treated with DOACs?

Population

16 patients (8 male, 8 female) with known diagnosis of atrial fibrillation, ejection fraction >40%, all on direct oral anticoagulants (DOACs).

Intervention

1 hour of physical activity with continuous Trans Cranial Doppler (TCD-X) monitoring.

Outcome

Incidence of micro-embolic signals (MES) during 1 hour of physical activity.surrogate

In a small cohort of AF patients on DOACs, 25% exhibited micro-embolic signals during 1 hour of physical activity, suggesting physical activity is not a major risk factor for embolic events in this treated population.

Limitations

Short registration time (1 h) compared to device potential (>6 h)
Small sample size
Lack of simultaneous bilateral recordings of MES

Abstract

BACKGROUND: Atrial fibrillation (AF) is a well-known risk factor for embolic stroke. The incidence of stroke in patients with AF is 4.5% per year. In 93% of cases, strokes in patients with AF are of embolic origin. Trans Cranial Doppler (TCD) monitoring of silent micro-embolic signals (MES) can represent an effective preclinical tool for verifying the efficacy of embolic events in patients treated with antithrombotic prophylaxis (antiplatelet agents, Vitamin K inhibitors, and new oral anticoagulants direct thrombin inhibitors). METHODS: We enrolled 16 patients, of both sexes equally distributed (M = 8 plus F = 8) with a known diagnosis of AF with Ejection Fraction greater of 40%, all in anticoagulant treatment by direct oral anticoagulants (DOACs) and we assessed, through the use of a portable TCD-X, the MES signals during physical activity of 1 h. The aim was of evaluating whether the physical activity of a subject affected by AF worsens the incidence of MES in these subjects. Result: 25% of patients presented a MES at the time of registration. Two female of 38 and 75 year-old. and two male of 70 and 71 year-old. The 75-year-old woman reported an episode of instability while walking; therefore it was increased her anticoagulant treatment. Men did not perceive the MES. CONCLUSION: Both sexes reported the presence of MES equally with a prevalence of 25%. By correlating these results with those of the literature, it is deduced that physical activity is, therefore, not a risk factor for these patients being treated with DOACs. The TDC-X registration implemented is relatively short compared to the current potential of the device which is over 6 h; therefore, it is desirable that further studies be performed in future on statistically adequate sample cohorts and simultaneous bilateral recordings of MES.