Vilches, SilviaFontana, MariannaGonzalez-Lopez, EstherMitrani, LindseySaturi, GiuliaRenju, MaryGriffin, Jan MCaponetti, AngeloGnanasampanthan, SahanaDe Los Santos, JeffenyGagliardi, ChristianRivas, AdrianDominguez, FernandoLonghi, SimoneRapezzi, ClaudioMaurer, Mathew SGillmore, JulianGarcia-Pavia, Pablo2023-03-162023-03-162022-08Eur J Heart Fail. 2022 Aug;24(8):1387-1396http://hdl.handle.net/20.500.12105/15647Although systemic embolism is a potential complication in transthyretin amyloid cardiomyopathy (ATTR-CM), data about its incidence and prevalence are scarce. We studied the incidence, prevalence and factors associated with embolic events in ATTR-CM. Additionally, we evaluated embolic events according to the type of oral anticoagulation (OAC) and the performance of the CHA2 DS2 -VASc score in this setting. Clinical characteristics, history of atrial fibrillation (AF) and embolic events were retrospectively collected from ATTR-CM patients evaluated at four international amyloid centres. Overall, 1191 ATTR-CM patients (87% men, median age 77.1 years [interquartile range-IQR 71.4-82], 83% ATTRwt) were studied. A total of 162 (13.6%) have had an embolic event before initial evaluation. Over a median follow-up of 19.9 months (IQR 9.9-35.5), 41 additional patients (3.44%) had an embolic event. Incidence rate (per 100 patient-years) was 0 among patients in sinus rhythm with OAC, 1.3 in sinus rhythm without OAC, 1.7 in AF with OAC, and 4.8 in AF without OAC. CHA2 DS2 -VASc did not predict embolic events in patients in sinus rhythm whereas in patients with AF without OAC, only those with a score ≥4 had embolic events. There was no difference in the incidence rate of embolism between patients with AF treated with vitamin K antagonists (VKAs) (n = 322) and those treated with direct oral anticoagulants (DOACs) (n = 239) (p = 0.66). Embolic events were a frequent complication in ATTR-CM. OAC reduced the risk of systemic embolism. Embolic rates did not differ with VKAs and DOACs. The CHA2 DS2 -VASc score did not correlate well with clinical outcome in ATTR-CM and should not be used to assess thromboembolic risk in this population.engVoRhttp://creativecommons.org/licenses/by-nc-nd/4.0/Atrial FibrillationCardiomyopathiesEmbolismHeart FailureStrokeAgedAnticoagulantsFemaleFibrinolytic AgentsHumansMalePrealbuminRetrospective StudiesRisk AssessmentRisk FactorsAttribution-NonCommercial-NoDerivatives 4.0 Internacional35650018248138710.1002/ejhf.25661879-0844European journal of heart failureopen access