Amyloid ( IF 5.2 ) Pub Date : 2020-08-19 , DOI: 10.1080/13506129.2020.1810010 Lindsey R Mitrani 1 , Jeffeny De Los Santos 2 , Elissa Driggin 1 , Rebecca Kogan 2 , Stephen Helmke 2 , Jeff Goldsmith 3 , Angelo B Biviano 4 , Mathew S Maurer 2
Abstract
Background
Atrial fibrillation (AF) is common in patients with transthyretin cardiac amyloidosis (ATTR-CA). The optimal strategy to prevent strokes in patients with ATTR-CA and AF is unknown.
Objectives
To compare outcomes in patients with ATTR-CA and AF treated with warfarin versus novel oral anticoagulants (NOACs).
Methods
This study was a retrospective analysis of patients with ATTR-CA stratified by presence or absence of AF and anticoagulation therapy. The primary outcome included a time to event analysis for the combined outcomes of stroke, transient ischaemic attack (TIA), major bleed, or death.
Results
Of 290 patients, 217 patients (74.8%) had AF. Of those with AF (n = 217), 78 (35.9%) patients received warfarin compared with 116 (53.5%) patients who received NOACs. There were 17 thrombotic events, all in those diagnosed with AF compared with none in the patients without AF (p = .01). Over a mean follow-up of 2.4 years (range 0.1–12) there was no difference in primary outcome between those with AF treated with warfarin compared with NOACs (p = .35).
Conclusion
Patient with ATTR-CA and AF are at increased risk for stroke compared to patients with ATTR-CA and without AF. Thrombotic events and major bleeds did not differ between those who received warfarin and NOACs.
中文翻译:
华法林抗凝与新型口服抗凝剂治疗转甲状腺素蛋白心脏淀粉样变性成人房颤的比较:血栓栓塞事件和大出血的比较
摘要
背景
心房颤动 (AF) 在转甲状腺素蛋白心脏淀粉样变性 (ATTR-CA) 患者中很常见。预防 ATTR-CA 和 AF 患者卒中的最佳策略尚不清楚。
目标
比较使用华法林与新型口服抗凝剂 (NOAC) 治疗的 ATTR-CA 和 AF 患者的结果。
方法
这项研究是对 ATTR-CA 患者的回顾性分析,根据是否存在 AF 和抗凝治疗进行分层。主要结果包括对中风、短暂性脑缺血发作 (TIA)、大出血或死亡等综合结果的事件发生时间分析。
结果
在 290 名患者中,217 名患者 (74.8%) 患有 AF。在 AF 患者 ( n = 217) 中,78 (35.9%) 名患者接受了华法林治疗,而 116 (53.5%) 名患者接受了 NOACs。有 17 起血栓事件,全部发生在被诊断为 AF 的患者中,而在没有 AF 的患者中没有发生 ( p = .01)。在平均 2.4 年(范围 0.1-12)的随访中,与 NOAC 相比,华法林治疗的 AF 患者的主要结局没有差异(p = .35)。
结论
与 ATTR-CA 和无 AF 的患者相比,ATTR-CA 和 AF 患者的卒中风险增加。接受华法林和 NOAC 的患者之间的血栓事件和大出血没有差异。