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Review
. 2024 Jun 3;16(6):e61557.
doi: 10.7759/cureus.61557. eCollection 2024 Jun.

Anticoagulation in Atrial Fibrillation Associated With Cardiac Amyloidosis: A Narrative Review

Tejbir S Monga  1 , Mfonido Ekong  2 , Kayé Patrick  3 , Tulasi Geethika Bommana Boyena  4 , Aneela Satya Ravanam  5 , Santiago Vargas  6 , Nur Bengisu Mavus  7 , A P Lakshmi  8 , Kanwaraj Singh  9 , Ramya Reshma Vegesna  10 , Kiran Abbas  11
Affiliations
Review

Anticoagulation in Atrial Fibrillation Associated With Cardiac Amyloidosis: A Narrative Review

Tejbir S Monga et al. Cureus. .

Abstract

Cardiac amyloidosis (CA) involves the abnormal deposition and accumulation of amyloid proteins in the heart muscle. A hallmark of disease progression is declining heart function, which can lead to structural irregularities, arrhythmias, and ultimately heart failure. Atrial fibrillation (AF) is the most common arrhythmia that presents in CA patients, and this arrhythmia is significant because it can moderately increase the risk of patients developing intracardiac thrombi, thereby putting them at risk for thromboembolic events. The management of this complication entails the use of anticoagulants like vitamin K antagonists and direct oral anticoagulants to reduce the risk of thrombus formation. This article seeks to review AF in CA and the use of anticoagulation therapy for the management and reduction of thromboembolic risk. The major conclusions of this review are centered around the need for safe administration of anticoagulant therapy to CA patients, regardless of their CHA2DS2-VASc risk score. This review highlights the importance of taking a multidisciplinary or collaborative approach to CA treatment to ensure that all aspects of this multifaceted disease can be properly managed while minimizing adverse events like bleeding risk and drug-drug interactions.

Keywords: amyloidosis al; anticoagul; atrial fibrillation (af); atrial fibrillation cardiac amyloidosis; attr amyloidosis.

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Conflict of interest statement

Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Illustration of the evaluation of CA in suspected patients
ATTR, transthyretin amyloidosis; CA, cardiac amyloidosis; LGE, late gadolinium enhancement; LV, left ventricular; NT-proBNP, N-terminal pro-B-type natriuretic peptide; sFLC, serum free light-chain Image credits: Tejbir S. Monga and Mfonido Ekong
See this image and copyright information in PMC

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