Antithrombotic therapy in patients with heart failure
- Wilson S Colucci, MD
Wilson S Colucci, MD
- Section Editor — Heart Failure
- Professor of Medicine
- Boston University School of Medicine
- Gregory YH Lip, MD, FRCPE, FESC, FACC
Gregory YH Lip, MD, FRCPE, FESC, FACC
- Professor of Cardiovascular Medicine
- The University of Birmingham, UK
Studies in patients with heart failure (HF), left ventricular systolic dysfunction, or both have noted high rates of thromboembolic events as compared to the general population. While more evidence is available on thromboembolic risk in patients with left ventricular systolic dysfunction (with or without HF), evidence suggests that HF with preserved ejection fraction is also be associated with excess thromboembolism and stroke risk. (See 'Epidemiology' below.)
Thrombus in the left heart chambers can lead to embolic stroke and other systemic embolic events, while pulmonary emboli and paradoxical emboli originate from either deep venous thrombus or thrombus in the right heart chambers. Low cardiac output, decreased physical activity, and peripheral edema all predispose to venous thrombi.
This topic will discuss the risk of thromboembolism and indications for anticoagulation in patients with HF.
Antithrombotic therapy in clinical settings that may be associated with HF is discussed separately:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- Incidence of thromboembolism or stroke in heart failure populations
- Heart failure as stroke risk factor
- PATHOGENESIS OF THROMBOEMBOLISM IN HEART FAILURE
- RISK FACTORS FOR THROMBOEMBOLISM
- Atrial fibrillation
- Left ventricular systolic dysfunction
- Left ventricular thrombus
- Clinical risk models
- ROLE OF ANTITHROMBOTIC THERAPY
- Our approach
- Evidence on antithrombotic therapy in HF
- - Antithrombotic therapy compared to placebo
- - Comparison of aspirin to warfarin
- - Risks of anticoagulation
- - Effect of aspirin on HF outcomes
- Recommendations of others
- SUMMARY AND RECOMMENDATIONS