Right Ventricular Dysfunction Complicates Time in Therapeutic Range in Heart Failure Patients Receiving Warfarin

Area of Science:

• Cardiology
• Pharmacology
• Internal Medicine

Background:

• Warfarin therapy is crucial for preventing thromboembolic events in heart failure (HF) patients.
• Optimizing warfarin's therapeutic range is essential for patient safety and treatment efficacy.
• Right ventricular dysfunction (RVD) is a common complication in HF, but its impact on anticoagulation is not fully understood.

Purpose of the Study:

• To investigate the association between echocardiographically determined RVD and time in therapeutic range (TTR) in HF patients on warfarin.
• To identify predictors of poor anticoagulation control in a large cohort of HF patients.

Main Methods:

• A cohort of 893 HF patients receiving warfarin was analyzed.
• Patients were categorized into four groups based on ejection fraction (preserved or reduced) and presence or absence of RVD.
• Baseline characteristics, clinical data, and warfarin therapy parameters were compared across groups.

Main Results:

• The presence of RVD was associated with significantly lower median TTR values in both HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) patients.
• Multivariate analysis identified RVD as an independent predictor of poor anticoagulation control.
• Other independent predictors included smoking, advanced NYHA functional class, hypertension, diabetes, pulmonary disease, prior stroke/TIA, and chronic kidney disease.

Conclusions:

• Echocardiographically demonstrated RVD in HF patients receiving warfarin therapy is a significant risk factor for suboptimal anticoagulation.
• RVD contributes to difficulties in achieving and maintaining the therapeutic range for warfarin.
• Clinical management of HF patients on warfarin should consider the assessment and potential impact of RVD on anticoagulation control.