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Management of heart failure. IV. Anticoagulation for patients with heart failure due to left ventricular systolic

D W Baker1, R F Wright

  • 1Health Sciences Program, RAND, Santa Monica, Calif.

JAMA
|November 23, 1994
PubMed

Insights

Arterial thromboembolism occurs in 0.9-5.5% of heart failure patients without anticoagulation. Anticoagulation is not recommended for heart failure patients in sinus rhythm due to insufficient evidence.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Clinical Research

Background:

  • Heart failure (HF) is a complex condition associated with increased risk of thromboembolic events.
  • Arterial thromboembolism is a significant concern in HF patients, particularly those not on anticoagulant therapy.
  • The role of ventricular dysfunction severity in influencing thromboembolic risk requires further clarification.

Purpose of the Study:

  • To review the incidence of arterial thromboembolism in patients with heart failure (HF) who are not receiving anticoagulants.
  • To examine if more severe ventricular dysfunction increases the incidence of thromboembolic events.
  • To assess the efficacy and risks of anticoagulation for HF patients in sinus rhythm.

Main Methods:

  • A systematic review of English-language studies from January 1966 to September 1993.
  • Databases searched included MEDLINE and EMBASE using terms related to heart failure and thromboembolism.
  • Studies included patients with chronic heart failure not on anticoagulants; excluded were those with valvular disease, secondary HF, or Chagas' disease.

Main Results:

  • The incidence of arterial thromboembolism ranged from 0.9 to 5.5 events per 100 patient-years.
  • The largest studies reported incidences of 2.0% and 2.4%.
  • Findings on the link between ventricular function and thromboembolic events were contradictory.

Conclusions:

  • No controlled trials have evaluated anticoagulation efficacy or risks in HF patients with sinus rhythm.
  • Reported efficacy of anticoagulation in case series varied widely (0% to 100%).
  • Anticoagulation is currently discouraged for heart failure patients in sinus rhythm due to a lack of adequate supporting studies.
Abstract

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