Acute limb ischemia and anticoagulation in patients with history of atrial fibrillation.

Background: Atrial fibrillation (AF) is the commonest source of arterial embolization causing acute limb ischemia (ALI). The aim of this study was to assess the adherence of anticoagulation in AF patients and the treatment of underdiagnosed AF patients, presenting with ALI in our service and to evaluate the risk factors associated with morbidity and mortality.

Methods: A retrospective analysis of prospectively collected data was carried out from 115 limbs of 112 consecutive patients presenting with ALI of AF origin from 2008 until 2012 to a tertiary vascular service.

Results: The mean transfer time to hospital was 12±8.5 h. On admission, only half of the patients were aware of having AF and only 67% of those patients were receiving oral anticoagulants at the time of their admission. Nearly all patients who were on Vitamin K Antagonists (VKA) had sub-therapeutic levels preoperatively on admission (92%). The 30-day postoperative mortality and morbidity rates were 1.7% and 47% respectively. The lower limb amputation rate was 4.4% and was only associated with diabetes mellitus (DM) (P=0.009553). Reversible renal impairment was correlated with increased creatinine phosphokinase (CPK) blood levels on admission (P=0.038).

Conclusions: A considerable number of patients with AF might still remain without proper anticoagulation. DM increases the risk of lower limb loss after ALI. Development of renal impairment after thromboembolectomy for ALI is more likely in the presence of elevated CPK blood levels on admission.