Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review
Transthyretin amyloidosis (ATTR) is a group of diseases caused by the deposition of insoluble fibrils derived from misfolded transthyretin, which compromises the structure and function of various organs, including the heart. Thromboembolic events and increased bleeding risk are among the most import...
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| Format: | Article |
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MDPI AG
2023-10-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/20/6640 |
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| author | Angela Napolitano Laura De Michieli Giulio Sinigiani Tamara Berno Alberto Cipriani Luca Spiezia |
| author_facet | Angela Napolitano Laura De Michieli Giulio Sinigiani Tamara Berno Alberto Cipriani Luca Spiezia |
| author_sort | Angela Napolitano |
| collection | DOAJ |
| description | Transthyretin amyloidosis (ATTR) is a group of diseases caused by the deposition of insoluble fibrils derived from misfolded transthyretin, which compromises the structure and function of various organs, including the heart. Thromboembolic events and increased bleeding risk are among the most important complications of ATTR, though the underlying mechanisms are not yet fully understood. Transthyretin plays a complex role in the coagulation cascade, contributing to the activation and regulation of the coagulation and fibrinolytic systems. The prevalence of atrial fibrillation, cardiac mechanical dysfunction, and atrial myopathy in patients with ATTR may contribute to thrombosis, though such events may also occur in patients with a normal sinus rhythm and rarely in properly anticoagulated patients. Haemorrhagic events are modest and mainly linked to perivascular amyloid deposits with consequent capillary fragility and coagulation anomalies, such as labile international-normalised ratio during anticoagulant therapy. Therefore, it is paramount to carefully stratify the thrombotic and haemorrhagic risks, especially when initiating anticoagulant therapy. Our review aims to ascertain the prevalence of thromboembolic and haemorrhagic events in ATTR and identify potential risk factors and predictors and their impact on antithrombotic therapy. |
| first_indexed | 2024-03-10T21:10:09Z |
| format | Article |
| id | doaj.art-b0affa7661db48cf947b6894f680033e |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T21:10:09Z |
| publishDate | 2023-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-b0affa7661db48cf947b6894f680033e2023-11-19T16:53:56ZengMDPI AGJournal of Clinical Medicine2077-03832023-10-011220664010.3390/jcm12206640Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A ReviewAngela Napolitano0Laura De Michieli1Giulio Sinigiani2Tamara Berno3Alberto Cipriani4Luca Spiezia5General Internal Medicine & Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padova University Hospital, 35128 Padova, ItalyDepartment of Cardiothoracic and Vascular Sciences & Public Health, Padova University Hospital, 35128 Padova, ItalyDepartment of Cardiothoracic and Vascular Sciences & Public Health, Padova University Hospital, 35128 Padova, ItalyHaematology Unit, Department of Medicine, Padova University Hospital, 35128 Padova, ItalyDepartment of Cardiothoracic and Vascular Sciences & Public Health, Padova University Hospital, 35128 Padova, ItalyGeneral Internal Medicine & Thrombotic and Haemorrhagic Diseases Unit, Department of Medicine, Padova University Hospital, 35128 Padova, ItalyTransthyretin amyloidosis (ATTR) is a group of diseases caused by the deposition of insoluble fibrils derived from misfolded transthyretin, which compromises the structure and function of various organs, including the heart. Thromboembolic events and increased bleeding risk are among the most important complications of ATTR, though the underlying mechanisms are not yet fully understood. Transthyretin plays a complex role in the coagulation cascade, contributing to the activation and regulation of the coagulation and fibrinolytic systems. The prevalence of atrial fibrillation, cardiac mechanical dysfunction, and atrial myopathy in patients with ATTR may contribute to thrombosis, though such events may also occur in patients with a normal sinus rhythm and rarely in properly anticoagulated patients. Haemorrhagic events are modest and mainly linked to perivascular amyloid deposits with consequent capillary fragility and coagulation anomalies, such as labile international-normalised ratio during anticoagulant therapy. Therefore, it is paramount to carefully stratify the thrombotic and haemorrhagic risks, especially when initiating anticoagulant therapy. Our review aims to ascertain the prevalence of thromboembolic and haemorrhagic events in ATTR and identify potential risk factors and predictors and their impact on antithrombotic therapy.https://www.mdpi.com/2077-0383/12/20/6640thromboembolic eventsbleeding eventstransthyretin amyloidosis |
| spellingShingle | Angela Napolitano Laura De Michieli Giulio Sinigiani Tamara Berno Alberto Cipriani Luca Spiezia Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review Journal of Clinical Medicine thromboembolic events bleeding events transthyretin amyloidosis |
| title | Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review |
| title_full | Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review |
| title_fullStr | Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review |
| title_full_unstemmed | Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review |
| title_short | Thromboembolic and Bleeding Events in Transthyretin Amyloidosis and Coagulation System Abnormalities: A Review |
| title_sort | thromboembolic and bleeding events in transthyretin amyloidosis and coagulation system abnormalities a review |
| topic | thromboembolic events bleeding events transthyretin amyloidosis |
| url | https://www.mdpi.com/2077-0383/12/20/6640 |
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