Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm

Gregory Y. H. Lip; Piotr Ponikowski; Felicita Andreotti; Stefan D. Anker; Gerasimos Filippatos; Shunichi Homma; Joao Morais; Patrick Pullicino; Lars H. Rasmussen; Francisco Marin; Deirdre A. Lane; J. McMurray; A. Hoes; J. Ten Berg; R. De Caterina; S. D. Kristensen; U. Zeymer

doi:10.1160/TH12-08-0578

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2012; 108(06): 1009-1022
DOI: 10.1160/TH12-08-0578

Consensus Document

Schattauer GmbH

Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm

An Executive Summary^{[
^#
]} of a joint Consensus Document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis

Gregory Y. H. Lip^*

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham UK

,

Piotr Ponikowski^**

²Departement of Heart Disease, Military Hospital, Medical University, Wroclaw, Poland

,

Felicita Andreotti^*

³Department of Cardiovascular Sciences, Catholic University Hospital, Rome, Italy

,

Stefan D. Anker

⁴Department of Cardiology, Campus Virchow-Klinikum, CharitéUniversitätsmedizin Berlin, Germany

,

Gerasimos Filippatos

⁵Department of Cardiology, Heart Failure Unit, Athens University Hospital Attikon, Athens, Greece

,

Shunichi Homma

⁶Cardiology Division, Columbia University Medical Center, New York, NY, USA

,

Joao Morais^*

⁷Cardiology Division. Santo Andre´s Hospital, Leiria, Portugal

,

Patrick Pullicino

⁸KentHealth, University of Kent, Kent, UK

⁹Department of Neurology and Neuroscience, New Jersey Medical School, Newark, New Jersey, USA

,

Lars H. Rasmussen

¹⁰Thrombosis Research Unit, Aalborg University Hospital, Faculty of Medicine, Aalborg University, Aalborg, Denmark

,

Francisco Marin

¹¹Department of Cardiology, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain

,

Deirdre A. Lane

¹University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham UK

,

J. McMurray

,

A. Hoes

,

J. Ten Berg

,

R. De Caterina

,

S. D. Kristensen

,

U. Zeymer

› Author Affiliations

Abstract

Summary

Chronic heart failure (HF) with either reduced or preserved left ventricular (LV) ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to heart failure can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thromboembolism and/or venous thromboembolism. This executive summary of a joint consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence, summarises ‘best practice’, and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is clearly recommended, and the CHA2DS2-VASc and HAS-BLED scores should be used to determine the likely risk-benefit ratio (thromboembolism prevention versus risk of bleeding) of oralnticoagulation. In HF patients with reduced LV ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Whilst there is the potential for a reduction in ischaemic stroke, there is currently no compelling reason to routinely use warfarin for these patients. Risk factors associated with increased risk of thromboembolic events should be identified and decisions regarding use of anticoagulation individualised. Patient values and preferences are important determinants when balancing the risk of thromboembolism against bleeding risk. Novel oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.

Note: The editorial process for this article was fully handled by Prof. Christian Weber, Editor in Chief.

Keywords

Heart failure - sinus rhythm - thromboembolism - antithrombotic therapy - warfarin - aspirin

Full Text

References

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