Haemostasis and Thrombosis: Observations on Atrial Fibrillation and Platelets

Abstract

Atrial fibrillation (AF) is a growing “epidemic” and carries an important morbidity and mortality due to associated thromboembolic complications. Thrombogenesis in AF has been studied elaborately but still remains complex. Virchow’s triad postulated 150 years ago still seems to hold good as the basis of thrombogenesis requiring abnormality in blood flow, vessel wall, and blood constituents. Among blood constituents abnormalities in hemostasis, platelets, and the endothelium have been identified leading to hypercoagulable state with varying contributions. While antiplatelet therapy is still widely used in AF, it only seems to offer marginal benefit in people with associated vascular risk factors and debatable benefit in people without associated risk factors. This chapter provides an overview of the role of platelets in the pathophysiology of thrombogenesis in AF and antiplatelet therapy in AF.