From the Guidelines
Patients with cardiac ATTR amyloidosis are at an increased risk of developing deep vein thrombosis (DVT) due to the disease's inherent factors, such as blood stasis and hypercoagulability, and therefore, prophylactic anticoagulation should be considered, especially in those with additional risk factors. The risk of DVT in these patients is elevated due to several factors, including restrictive cardiomyopathy, reduced mobility, and hypercoagulability caused by the interaction between amyloid fibrils and clotting factors, as well as endothelial dysfunction caused by amyloid deposits in blood vessel walls 1. According to the 2022 AHA/ACC/HFSA guideline for the management of heart failure, intracardiac thrombosis occurs in approximately one-third of patients with cardiac amyloidosis, in some cases in the absence of diagnosed AF, and the use of anticoagulation reduced the risk of intracardiac thrombi in a retrospective study 1. Some key points to consider in the management of DVT risk in patients with cardiac ATTR amyloidosis include:
- Regular monitoring for signs of DVT, such as leg swelling, pain, or warmth, is important for early detection and treatment
- Maintaining mobility when possible and adequate hydration are also important preventive measures for these patients
- The choice of direct oral anticoagulants (DOAC) versus warfarin has not been studied in patients with ATTR, nor has the role of left atrial appendage closure devices 1. Overall, the management of DVT risk in patients with cardiac ATTR amyloidosis requires a comprehensive approach that takes into account the patient's individual risk factors and medical history.
From the Research
Risk of Developing DVT in Patients with Cardiac Amyloidosis
- The provided studies do not directly address the risk of developing Deep Vein Thrombosis (DVT) in patients with cardiac amyloidosis 2, 3, 4, 5, 6.
- However, it is known that patients with cardiac amyloidosis are at increased risk of thromboembolic events due to the disease's effect on the heart and blood vessels.
- The studies focus on the diagnosis, treatment, and management of cardiac amyloidosis, highlighting the importance of early recognition and tailored approaches to management 3, 5.
- Some studies discuss the use of advanced imaging modalities and biomarkers for diagnosis, as well as the availability of targeted therapies for certain types of cardiac amyloidosis 4, 6.
- Despite the lack of direct evidence on DVT risk, clinicians should be aware of the potential for thromboembolic complications in patients with cardiac amyloidosis and consider appropriate preventive measures and monitoring 5.