Abstract 15073: Best Anticoagulation Strategy for Stroke Prophylaxis in Atrial Fibrillation Patients With Amyloidosis

• Published in: Circulation (New York, N.Y.) N.Y.), 2020-11, Vol.142 (Suppl_3 Suppl 3), p.A15073-A15073
• Main Authors: Mohanty, Sanghamitra, TRIVEDI, CHINTAN G, Gallinghouse, Joseph, Della Rocca, Domenico G, Gianni, Carola, MacDonald, Bryan, Mayedo, Angel, Bassiouny, Mohamed, Gallinghouse, G, Burkhardt, John, Horton, Rodney, Al-ahmad, Amin, Natale, Andrea
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.142.suppl_3.15073

BackgroundA considerable proportion of elderly patients are known to have coexistent atrial fibrillation (AF) and amyloidosis. Both conditions increase stroke risk. ObjectiveWe evaluated the best anticoagulation strategy in a series of AF patients with amyloidosis. MethodsConsecutive AF patients with coexistent amyloidosis undergoing catheter ablation at our center were included in the analysis. Based on the stroke-prophylaxis approach they were divided into 2 groups; group 1left atrial appendage occlusion (LAAO) with Watchman and group 2oral anticoagulation. Following LAAO, all patients remained on full dose non-vitamin K oral anticoagulants (NOAC) for 45 days. Transesophageal echocardiogram (TEE) was performed at 45 days to assess completeness of closure. If the occlusion was complete, patients were kept on aspirin, 81 mg/day for long-term. In case of leak or dense ‘smoke’ in the left atrium (LA) or enlarged LA, they were prescribed half-dose NOAC. NOACs included dabigatran, apixaban, endoxaban and rivaroxaban. Group 2 patients remained on full-dose NOAC during the whole study period (1 year). All patients were prospectively followed up for 1 year. ResultsA total of 87 patients were included in the analysis; group 156 and group 231. CHA2DS2-VASc score was comparable between the groups (gr. 13.7±1.6 and gr. 23.2±1.7, p=0.18). The most commonly used NOACs were apixaban (45, 51.7%) and rivaroxaban (34, 39%). After the 45-day TEE, 34 patients from group 1 remained on baby-aspirin and 22 on half-dose NOAC. Of the 22, 12 patients had leaks