Cardioembolic stroke in cardiac amyloidosis: the real challenge lies beyond heart rhythm

Giampatzis, Vasilios; Musumeci, Beatrice; Tini, Giacomo

doi:10.1093/ehjcr/ytad246

Cited by 1 publication

(1 citation statement)

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“…25 If formation. 26 Moreover, extracardiac factors such as the hypercoagulable state from the circulating proteins and frequent occurrence of transient or persistent renal impairment also contribute to the higher thrombotic risk. 26 Thus, it is understandable that in the presence of two highly prothrombotic conditions, namely AF and amyloidosis, there has to be a very efficient strategy to prevent stroke or device thrombus.…”

Section: Discussionmentioning

confidence: 99%

Best anticoagulation strategy with and without appendage occlusion for stroke‐prophylaxis in postablation atrial fibrillation patients with cardiac amyloidosis

Mohanty,

Torlapati,

La Fazia

et al. 2024

Cardiovasc electrophysiol

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IntroductionBoth atrial fibrillation (AF) and amyloidosis increase stroke risk. We evaluated the best anticoagulation strategy in AF patients with coexistent amyloidosis.MethodsConsecutive AF patients with concomitant amyloidosis were divided into two groups based on the postablation stroke‐prophylaxis approach; group 1: left atrial appendage occlusion (LAAO) in eligible patients and group 2: oral anticoagulation (OAC). Group 1 patients were further divided into Gr. 1A: LAAO + half‐does NOAC (HD‐NOAC) for 6 months followed by aspirin 81 mg/day and Gr. 1B: LAAO + HD‐NOAC. In group 1 patients, with complete occlusion at the 45‐day transesophageal echocardiogram, patients were switched to aspirin, 81 mg/day at 6 months. In case of leak, or dense “smoke” in the left atrium (LA) or enlarged LA, they were placed on long‐term half‐dose (HD) NOAC. Group 2 patients remained on full‐dose NOAC during the whole study period.ResultsA total of 92 patients were included in the analysis; group 1: 56 and group 2: 36. After the 45‐day TEE, 31 patients from group 1 remained on baby‐aspirin and 25 on HD NOAC. At 1‐year follow‐up, four stroke, one TIA and six device‐thrombus were reported in group 1A, compared to none in patients in group 1B (5/31 vs. 0/25, p = .03). No bleeding events were reported in group 1, whereas group 2 had five bleeding events (one subdural hematoma, one retinal hemorrhage, and four GI bleedings). Additionally, one stroke was reported in group 2 that happened during brief discontinuation of OAC.ConclusionIn patients with coexistent AF and amyloidosis, half‐dose NOAC following LAAO was observed to be the safest stroke‐prophylaxis strategy.

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Section: Discussionmentioning

confidence: 99%