Suggested Citation Isleyici, T. K. (2025). Atrial Fibrillation Complicated by Spleen Infarction Due to Suboptimal Anticoagulation With Aspirin. 12th Intercontinental Emergency Medicine Congress (ICEM25), Antalya, Turkey.https://doi.org/10.5281/zenodo.18637595 Introduction and Purpose: Atrial fibrillation (AF) is a significant risk factor for thromboembolic events, particularly in the elderly. The CHA2DS2-VASc score is a widely used tool to assess thromboembolic risk in AF patients and guide anticoagulation therapy decisions. However, aspirin’s role in stroke prevention for AF patients has diminished over time, as recent studies show limited efficacy in reducing thromboembolic risk. Aspirin is now reserved for low-risk patients (CHA2DS2-VASc ≤ 1), as this case highlights its limitations in preventing thromboembolic complications in high-risk atrial fibrillation. Materials and Methods: An 81-year-old male presented with a three-day history of severe left-sided abdominal pain, different from his usual chronic constipation. His medical history included hypertension, BPH, type 2 diabetes and atrial fibrillation. He had been under regular cardiac follow-up, with his last check-up two months ago. His regular medications consisted of diltiazem, amlodipine, metformin, dutasteride, and acetylsalicylic acid. There were no additional gastrointestinal or urinary symptoms. On examination, the patient was haemodynamically stable with no abdominal tenderness. This absence of peritoneal signs, despite patient’s own expression significant pain, raised concern for ischemia-related aetiologies, prompting us for further evaluation. Initial laboratory investigations, including a comprehensive biochemistry panel and measurement of amylase and lipase, were unremarkable. The only significant finding was a mildly elevated C-reactive protein (CRP) level of 59.9 mg/dL. The emergency electrocardiogram (ECG) was consistent with atrial fibrillation, while troponin-I level was within the normal limit. Abdominal and chest X-rays showed no significant findings. Given the patient’s disproportionate pain and inconclusive initial investigations, a contrast-enhanced abdominal CT was ordered, which confirmed a diagnosis of splenic infarction. Early consultation with the on-call surgical and cardiology teams was conducted, and the anaesthesia team subsequently accepted the patient for admission to ICU. Anticoagulation, antihypertensive, and antiarrhythmic therapies were promptly initiated. After stabilisation, anticoagulation therapy was switched to rivaroxaban 20 mg daily for long-term management. Results and Conclusion: This case highlights the limitations of aspirin monotherapy in preventing thromboembolic events in atrial fibrillation, especially in high-risk patients. Evidence suggests aspirin provides minimal stroke risk reduction and may contribute to embolic complications. It underscores the need for guideline-directed anticoagulation therapy for optimal stroke prevention and patient outcomes. (Presented as an oral presentation at the 12th Intercontinental Emergency Medicine Congress (ICEM25), Antalya, April 2025)
Taha Kaan Isleyici (Thu,) studied this question.