Blood Coagulation Disorders in Heart Failure: From Basic Science to Clinical Perspectives

Area of Science:

• Cardiology
• Hematology

Background:

• Heart failure (HF) is a syndrome with 3 subtypes, each carrying unique risks for thromboembolic complications, including stroke and pulmonary embolism.
• Despite a 1% annual prevalence and severe outcomes, thromboembolic issues in HF are often underappreciated.
• Current data do not support routine anticoagulation for HF patients in sinus rhythm, but some evidence suggests benefit in high-risk subsets.

Purpose of the Study:

• To review current data on coagulation disorders in acute and chronic HF.
• To summarize evidence on anticoagulation strategies in specific HF patient groups.
• To outline future research for optimal, patient-tailored antiplatelet and anticoagulant therapies in HF.

Main Methods:

• Comprehensive review of preclinical and clinical studies on coagulation in HF.
• Analysis of existing evidence regarding anticoagulation in HF special-case scenarios.
• Identification of research gaps and future directions for therapeutic strategies.

Main Results:

• HF subtypes present distinct clinical profiles and comorbidities, elevating thromboembolic risk.
• Thromboembolic complications are a significant, yet often overlooked, clinical challenge in HF management.
• Initial reports indicate potential benefits of anticoagulation in select HF patients with high thromboembolic risk.

Conclusions:

• Further research is critical to understand platelet activation in HF and evaluate antiplatelet/antithrombotic therapy efficacy.
• Optimal patient-tailored strategies for antiplatelet and anticoagulant therapy in HF require further investigation.
• Top 10 management pearls for HF patients without other indications for oral anticoagulation are highlighted.