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Anticoagulation Therapy in Specific Cardiomyopathies: Isolated Left Ventricular Noncompaction and Peripartum

Kazuhiko Kido1,2, Maya Guglin3

  • 11 Department of Pharmacy Practice, South Dakota State University, Sioux Falls, SD, USA.

Journal of Cardiovascular Pharmacology and Therapeutics
|June 19, 2018
PubMed

Insights

Anticoagulation is not routinely needed for left ventricular noncompaction (LVNC) unless thromboembolism risks exist. Peripartum cardiomyopathy (PPCM) patients may benefit from anticoagulation, especially with low ejection fraction or bromocriptine treatment.

Area of Science:

  • Cardiology
  • Hematology

Background:

  • Left ventricular noncompaction (LVNC) and peripartum cardiomyopathy (PPCM) are distinct cardiac conditions.
  • Anticoagulation therapy is frequently employed in clinical practice for both LVNC and PPCM.
  • The necessity and efficacy of anticoagulation in these conditions require further clarification.

Purpose of the Study:

  • To systematically review the evidence regarding anticoagulation therapy in patients with LVNC.
  • To evaluate the role of anticoagulation in patients diagnosed with PPCM.
  • To provide evidence-based recommendations for anticoagulation use in these specific patient populations.

Main Methods:

  • A systematic literature review was conducted.
  • Studies investigating anticoagulation in LVNC and PPCM were identified and analyzed.
  • Data on thromboembolism events, ejection fraction, and treatment outcomes were extracted.

Main Results:

  • LVNC itself is not associated with increased thromboembolism rates; anticoagulation is not indicated solely for LVNC without other risk factors.
  • Prophylactic anticoagulation may be considered for LVNC patients with low ejection fraction (EF < 40%) or atrial fibrillation.
  • Intracardiac thrombi detected via imaging warrant anticoagulation in LVNC.
  • Limited evidence exists for PPCM, but anticoagulation is recommended for PPCM patients with EF < 35% until recovery, and for those treated with bromocriptine.

Conclusions:

  • Routine anticoagulation is not justified for LVNC in the absence of specific thromboembolic risk factors.
  • Anticoagulation decisions in LVNC should be individualized based on ejection fraction, atrial fibrillation, and presence of thrombi.
  • Anticoagulation is recommended for PPCM patients with significantly reduced ejection fraction or undergoing bromocriptine therapy, pending further research.

Keywords:
anticoagulationcardiomyopathynoncompactionperipartum cardiomyopathy

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