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The rate of systemic embolism among patients with ATTR-CM is not well-researched, and this study aims to understand how this complication correlates with other common factors affecting this population.

Among patients with transthyretin amyloid cardiomyopathy (ATTR-CM), systemic embolism is a possible complication. However, data about the prevalence of systemic embolism in this population are scarce, and may relate to other types of embolic events, as well. This study, published in the European Journal of Heart Failure, attempts to evaluate the incidence, prevalence, and factors including clinical, analytical, and echocardiographic characteristics associated with embolic events in patients with ATTR-CM. Embolic events were also evaluated according to the type of oral anticoagulation and the performance of the CHA2DS2‐VASc score.

The data for this study were collected from patients with ATTR-CM at four international amyloid centers. The researchers collected data on the clinical characteristics of disease in these patients, along with atrial fibrillation and embolic events. The study relied on data from a total of 1,191 patients, of which 87% were men, and the median age was 77.1 years. Of these, 162 patients (13.6%) had a history of an embolic event prior to evaluation, and 41 additional patients experienced an embolic event in the following 19.9 months. The overall incidence rate per 100 patient-years was 0 among patients in sinus rhythm with oral anticoagulation, and 4.8 in atrial fibrillation without oral anticoagulation. Among patients who received atrial fibrillation without oral anticoagulation only those with CHA2DS2-VASc scores greater than four experienced embolic events.

The authors conclude by noting that embolic events were a frequent complication of ATTR-CM. Oral anticoagulation did reduce the risk of systemic embolism, and embolic rates did not differ with vitamin K antagonists and direct oral anticoagulants. The CHA2DS2‐VASc score was found to not correlate well enough with the clinical outcome in ATTR-CM to warrant using it to assess thromboembolic risk among patients with ATTR-CM.

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Vilches, S., Fontana, M., Gonzalez-Lopez, E., Mitrani, L., Saturi, G., Renju, M., Griffin, J. M., Caponetti, A., Gnanasampanthan, S., De Los Santos, J., Gagliardi, C., Rivas, A., Dominguez, F., Longhi, S., Rapezzi, C., Maurer, M. S., Gillmore, J., & Garcia-Pavia, P. (2022). Systemic embolism in amyloid transthyretin cardiomyopathy. European Journal of Heart Failure, 24(8), 1387-1396. https://doi.org/10.1002/ejhf.2566