Venous thromboembolic disease in congestive heart failure

Congestive heart failure (CHF) is a medical condition associated with a relatively high risk of venous thromboembolism (VTE). Without thromboprophylaxis, venographically proven deep vein thrombosis occurs in 10% to 22% of hospitalized patients with CHF. Although the elevated VTE risk associated with CHF has been attributed to a variety of abnormalities in the context of Virchow's triad, newer information suggests that an associated chronic inflammatory state may be culpable. Both traditional VTE risk factors and cardiac-specific risk factors further increase the risk of VTE in patients with CHF. Severe left ventricular dysfunction, clinical instability (New York Heart Association class III-IV), young age, and/or right ventricular dysfunction appear to enhance the VTE risk associated with CHF. Grade IA pharmacologic thromboprophylactic recommendations for the hospitalized CHF patient include low molecular weight-heparin, fondaparinux, and low-dose unfractionated heparin. Regrettably, a variance in societal guidelines on the importance of VTE in hospitalized CHF patients may lead to underutilization of thromboprophylaxis.