What do we know about anticoagulation in patients with heart failure?

The risk of thromboembolic events in heart failure patients is estimated to be in the range of 1-4.5% per year. To date, there are insufficient data to guide us in appropriate use of antithrombotic or antiplatelet drug therapy to decrease the risk of events in this population. This review will outline the existing literature on anticoagulation and heart failure.

Until recently, no randomized controlled data existed to identify the risks and benefits of anticoagulation in heart failure patients. Three recent trials have attempted to shed light on this topic. Unfortunately, these studies have been of limited value due to poor recruitment and are underpowered to definitively answer these questions.

Until additional randomized control data are available, the routine use of anticoagulation for heart failure patients cannot be advocated. Limited data suggest that the benefits of anticoagulation may outweigh the risks in the following categories: ejection fraction less than 20%; left ventricular systolic dysfunction and history of previous stroke; and known thrombus in the left or right ventricle. We eagerly await the completion of the Warfarin Aspirin Reduced Cardiac Ejection Fraction Study.