[Antithrombotic prophylaxis in patients with ventricular dysfunction: critical review of the literature and new...

Area of Science:

• Cardiology
• Neurology
• Thrombosis Research

Context:

• Heart failure (HF) is linked to an increased annual stroke risk of ~1.2%.
• Vascular occlusion, not arrhythmias, may be the primary cause of sudden death in chronic HF.
• Existing antithrombotic therapy recommendations are limited to specific high-risk HF subgroups.

Purpose:

• To review the current evidence and controversies surrounding antithrombotic therapy in heart failure patients with ventricular dysfunction in sinus rhythm.
• To highlight the need for further clinical trials investigating antiplatelet agents and anticoagulation in HF.
• To discuss emerging therapeutic options for thromboembolism prevention in HF.

Summary:

• Observational data indicate a notable stroke risk in heart failure patients.
• Anticoagulation's role is debated, with current indications restricted to high-risk patients (e.g., atrial fibrillation, existing thrombi, prior thromboembolism).
• Evidence for aspirin in preventing thromboembolism in HF patients with preserved sinus rhythm is lacking; large trials like WATCH and WARCEF are pending.

Impact:

• Clarifies current treatment paradigms for thromboembolism prevention in heart failure.
• Identifies critical knowledge gaps necessitating further research in antiplatelet and anticoagulation therapies.
• Suggests future therapeutic directions, including novel oral direct thrombin inhibitors like ximelagatran.