Haemorrhagic events in patients with transthyretin cardiac amyloidosis

transthyretin cardiac amyloidosis (ATTR-CA) is an infiltrative disease associated with several comorbidities such as Bleeding. The aim of this study was to evaluate the incidence of bleeding in patients with ATTR-CA and the underlying risk factors that promote bleeding. retrospective observational study of a cohort of patients with ATTR-CA diagnosed from 1st April 2016 to 31st December 2023. Bleeding risk was calculated according to HAS-BLED score and bleeding events at follow-up were analysed. 184 patients were diagnosed with a median age of 84 years [IQR 79–88], 154 (84%) males. 118 patients (64%) were on anticoagulant therapy (AC). 91 patients (50%) had a bleeding event, with a total of 189 events recorded and a median time to bleeding of 23 months [IQR 10–68]. 26 patients (29%) had severe haemorrhages and 3 patients died of haemorrhagic causes. The incidence rate was 50 bleeds per 100 patient-years and 57 per 100 patient-years in AC patients. AC resulted in a 2.5-fold raise in bleeding (95% CI 1.4–4.8; p = .003) and a score ≥2 on HAS-BLED scale in a 5.4-fold increase (95%CI 2.6–11; p bleeding is a frequent complication in ATTR-CA, with a higher risk in those individuals with a HAS-BLED score ≥2 and/or on AC. These findings could be considered in risk stratification and therapeutic decision-making.