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

D. W. Baker and R. F. Wright
Health Sciences Program, RAND, Santa Monica, Calif.

OBJECTIVE--This article reviews the incidence of arterial thromboembolism in patients with heart failure who are not receiving anticoagulants. We also examine whether more severe ventricular dysfunction increases this incidence and the efficacy and risks of anticoagulation for patients in sinus rhythm. DATA SOURCES--English-language studies referenced in MEDLINE or EMBASE (January 1966 to September 1993) were reviewed. We used the search terms heart failure, congestive; congestive heart failure; heart failure; cardiac failure; and dilated cardiomyopathy in conjunction with the terms anticoagulation, cerebrovascular disorders, stroke, and thromboembolism. STUDY SELECTION--All studies with separate data for patients with chronic heart failure not receiving anticoagulants were included. Articles addressing valvular heart disease or heart failure secondary to acute myocardial infarction or Chagas' disease were excluded. Studies of the occurrence of left ventricular mural thrombi were also reviewed. DATA EXTRACTION AND SYNTHESIS--Inclusion and exclusion criteria, prevalence of atrial fibrillation, mean follow-up, and the occurrence of arterial thromboembolic events were extracted. If the incidence was not given, this was estimated using the proportion of patients with events divided by the mean follow-up. CONCLUSION--The incidence of arterial thromboembolism ranged from 0.9 to 5.5 events per 100 patient-years, with the largest studies reporting incidence of 2.0% and 2.4%. Findings regarding the relationship between ventricular function and thromboembolic events are contradictory. No controlled trial has assessed the efficacy or risks of anticoagulation for patients with heart failure and sinus rhythm, and reported efficacy in case series ranged from 0% to 100%. Until adequate studies are performed, anticoagulation should be discouraged for patients with heart failure who are in sinus rhythm.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Antithrombotic Therapy in Neonates and Children: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Monagle et al.
Chest 2008;133:887S-968S.
ABSTRACT | FULL TEXT  

Thromboembolic complications in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy
Wlodarska et al.
Europace 2006;8:596-600.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy in Children*: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Monagle et al.
Chest 2004;126:645S-687S.
ABSTRACT | FULL TEXT  

Atrial fibrillation and heart failure: natural history and pharmacological treatment
Savelieva and John Camm
Europace 2003;5:S5-S19.
ABSTRACT | FULL TEXT  

What is the optimal medical management of ischaemic heart failure?
Cleland et al.
Br Med Bull 2001;59:135-158.
ABSTRACT | FULL TEXT  

Heart failure
Francis
J Am Coll Cardiol 2000;35:6B-9B.
 

Heart failure
Francis
J Am Coll Cardiol 1999;33:291-294.
FULL TEXT  

Pharmacologic Management of Chronic Heart Failure: A Review
Abraham
SEMIN CARDIOTHORAC VASC ANESTH 1998;2:168-190.
ABSTRACT  

Ventricular Dysfunction and the Risk of Stroke after Myocardial Infarction
Loh et al.
NEJM 1997;336:251-257.
ABSTRACT | FULL TEXT  

Guidelines for the Evaluation and Management of Heart Failure : Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines (Committee on Evaluation and Management of Heart Failure)
COMMITTEE MEMBERS et al.
Circulation 1995;92:2764-2784.
FULL TEXT