Antithrombotic treatment in cardiac amyloidosis
Révész Katalin1, Apor Astrid2, Nagy Daniella1, Pozsonyi Zoltán1
1Semmelweis Egyetem, Belgyógyászati és Hematológiai Klinika, Budapest
2Semmelweis Egyetem, Városmajori Szív- és Érgyógyászati Klinika, Budapest
Systemic amyloidosis is a rare, progressive, infiltrative disease caused by amiloid fibril deposits. Cardiac involvement is present in immunoglobulin light chain and variant or wild-type transthyretin amyloidosis. In recent years, incidence has been increasing, and survival has been improving due to new therapeutic options. Patient management is challenging and needs special considerations. Due to high thromboembolic risk and frequently observed intracardiac thrombi, all patients with atrial fibrillation need anticoagulant therapy. Antithrombotic treatment should also be considered in selected cases in sinus rhythm. On the other hand, bleeding risk is also increased. Due to lack of specific guidelines, physicians should base their therapeutic decision-making on individualized assessment of thrombotic and haemorrhagic risks. Both vitamin K antagonists and direct oral anticoagulants are acceptable alternatives of antithrombotic treatment.