• Lindsey R Mitrani, Jeffeny De Los Santos, Elissa Driggin, Rebecca Kogan, Stephen Helmke, Jeff Goldsmith, Angelo B Biviano, and Mathew S Maurer.
• Department of Internal Medicine, New York Presbyterian/Columbia University Medical Center, New York City, NY, USA.
• Amyloid. 2021 Mar 1; 28 (1): 30-34.

BackgroundAtrial 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.ObjectivesTo compare outcomes in patients with ATTR-CA and AF treated with warfarin versus novel oral anticoagulants (NOACs).MethodsThis 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.ResultsOf 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).ConclusionPatient 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.

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