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Antithrombotic therapy for atrial fibrillation in hereditary hemorrhagic telangiectasia

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Abstract

Antithrombotic therapy reduces stroke risk in patients with atrial fibrillation but at the cost of increased bleeding risk. Patients with hereditary hemorrhagic telangiectasia (HHT) are at increased bleeding risk due to fragile mucocutaneous telangiectasias and visceral arteriovenous malformations. These patients are simultaneously at elevated thrombotic risk due to the vascular abnormalities of HHT. Managing atrial fibrillation in patients with HHT represents an understudied and challenging clinical scenario. We present a retrospective cohort study investigating antithrombotic therapy in patients with HHT and atrial fibrillation. We found that antithrombotic therapy was poorly tolerated, leading to premature dose-reduction or discontinuation of therapy in a majority of patients and in a majority of treatment episodes. Five patients undergoing left atrial appendage procedures did well despite difficulties completing the prescribed course of post-procedure antithrombotic therapy. Left atrial appendage occlusion or simultaneous administration of systemic anti-angiogenic therapy may represent alternatives but require additional study in patients with HHT.

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Acknowledgements

Hanny Al-Samkari receives support from the National Institutes of Health/National Heart, Lung, and Blood Institute (1K23HL159313) and is the recipient of the American Society of Hematology Scholar Award.

Disclosures

Virk: None. Richardson: None. H. Al-Samkari: Research Funding to Institution (Agios, Sobi, Amgen, Novartis, Vaderis); Consultancy (Agios, Sobi, Forma, Rigel, argenx, Moderna, Novartis).

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Authors and Affiliations

  1. Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Zain M. Virk & T. Lee Richardson

  2. Division of Cardiology, Department of Internal Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    T. Lee Richardson

  3. Division of Hematology Oncology, Massachusetts General Hospital, Suite 118, Room 112 Zero Emerson Place, Boston, MA, 02114, USA

    Hanny Al-Samkari

  4. Harvard Medical School, Boston, MA, USA

    Hanny Al-Samkari

Authors
  1. Zain M. Virk
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  2. T. Lee Richardson
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  3. Hanny Al-Samkari
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Correspondence to Hanny Al-Samkari.

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Virk, Z.M., Richardson, T.L. & Al-Samkari, H. Antithrombotic therapy for atrial fibrillation in hereditary hemorrhagic telangiectasia. J Thromb Thrombolysis 56, 355–359 (2023). https://doi.org/10.1007/s11239-023-02839-1

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  • DOI: https://doi.org/10.1007/s11239-023-02839-1

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