Anticoagulation for heart failure: selecting the best therapy

Heart failure (HF) incidence approaches 10 per 1000 population after the age of 65 years, and is the most common Medicare diagnosis. The management of HF patients has improved over the last decade, but the risk of thromboembolic complications is frequently underestimated and currently, no treatment options have been formally implemented to decrease the incidence of events. In particular, stroke is a major complication of HF. HF ranks second after atrial fibrillation in the number of cardiogenic strokes caused. The actual rate of stroke in recent HF trials ranges between 1.5 and 2.4% per year. Warfarin is of proven efficacy in patients with ischemic heart disease and atrial fibrillation, but there has been little research testing antithrombotic agents in patients with HF. Aspirin may be another promising drug, but trials have shown a higher rate of HF admissions with aspirin, suggesting that aspirin may attenuate the angiotensin-converting enzyme inhibitor effect on cardiac function. We eagerly await the completion of large, randomized trials to help guide us in these important issues affecting a large number of patients.