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Thromboembolism and bleeding in systemic amyloidosis: a review
Martin Nicol1,2, Virginie Siguret2,3,4, Giuseppe Vergaro5
1Cardiology department, Lariboisière Hospital, APHP, 2 rue Ambroise Paré, Paris, France.
ESC Heart Failure
|November 16, 2021
Summary
Systemic amyloidosis patients face significant risks of blood clots (thromboembolic events) and bleeding. Early identification and management of these risks are crucial for improving patient prognosis and care.
Area of Science:
- Hematology
- Cardiology
- Internal Medicine
Background:
- Thromboembolic and bleeding risks in systemic amyloidosis are under-recognized.
- These complications significantly impact patient prognosis.
Purpose of the Study:
- To review current evidence on thromboembolic and bleeding risks in systemic amyloidosis.
- To provide a clinical perspective on managing these risks.
Main Methods:
- Narrative review of existing literature.
- Clinical perspective synthesis.
Main Results:
- Thromboembolic events occur in 5-10% of amyloidosis patients, especially with cardiac involvement.
- Key pro-thrombotic factors include heart failure, atrial fibrillation (20-75%), and atrial myopathy.
- Cardiac thrombi found in up to 30% of AL amyloidosis patients; systematic screening before cardioversion is recommended.
- Bleeding risk is elevated due to digestive involvement, Factor X deficiency, renal failure, and dysautonomia.
Conclusions:
- Systemic amyloidosis presents complex thromboembolic and bleeding challenges.
- Proactive risk assessment and management are essential for improving outcomes in amyloidosis patients.
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