Τίτλος:
Blood Coagulation Disorders in Heart Failure: From Basic Science to Clinical Perspectives
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Heart failure (HF) is a clinical syndrome that is divided into 3 subtypes based on the left ventricular ejection fraction. Every subtype has specific clinical characteristics and concomitant diseases, substantially increasing risk of thromboembolic complications, such as stroke, peripheral embolism and pulmonary embolism. Despite the annual prevalence of 1% and devastating clinical consequences, thromboembolic complications are not typically recognized as the leading problem in patients with HF, representing an underappreciated clinical challenge. Although the currently available data do not support routine anticoagulation in patients with HF and sinus rhythm, initial reports suggest that such strategy might be beneficial in a subset of patients at especially high thromboembolic risk. Considering the existing evidence gap, we aimed to review the currently available data regarding coagulation disorders in acute and chronic HF based on the insight from preclinical and clinical studies, to summarize the evidence regarding anticoagulation in HF in special-case scenarios and to outline future research directions so as to establish the optimal patient-tailored strategies for antiplatelet and anticoagulant therapy in HF. In summary, we highlight the top 10 pearls in the management of patients with HF and no other specific indications for oral anticoagulation therapy. Further studies are urgently needed to shed light on the pathophysiological role of platelet activation in HF and to evaluate whether antiplatelet or antithrombotic therapy could be beneficial in patients with HF. Lay Summary: Heart failure (HF) is a clinical syndrome divided into 3 subtypes on the basis of the left ventricular systolic function. Every subtype has specific clinical characteristics and concomitant diseases, substantially increasing the risk of thromboembolic complications, such as stroke, peripheral embolism and pulmonary embolism. Despite the annual prevalence of 1% and devastating clinical consequences, thromboembolic complications are not typically recognized as the leading problem in patients with HF, representing an underappreciated clinical challenge. Although the currently available data do not support routine anticoagulation in patients with HF and no atrial arrhythmia, initial reports suggest that such a strategy might be beneficial in a subset of patients at especially high risk of thrombotic complications. Considering the existing evidence gap, we aimed to review the currently available data regarding coagulation problems in stable and unstable patients with HF based on the insight from preclinical and clinical studies, to summarize the evidence regarding anticoagulation in HF in specific patient groups and to outline future research directions to establish the optimal strategies for antiplatelet and anticoagulant therapy in HF, tailored to the needs of an individual patient. In summary, we highlight the top 10 pearls in the management of patients with HF and no other specific indications for oral anticoagulation therapy. © 2023 The Author(s)
Συγγραφείς:
SINIARSKI, A.
GĄSECKA, A.
BOROVAC, J.A.
PAPAKONSTANTINOU, P.E.
BONGIOVANNI, D.
EHRLINDER, H.
GIUSTOZZI, M.
GUERREIRO, R.A.
PARKER, W.A.E.
Περιοδικό:
Journal of Cardiac Failure
Λέξεις-κλειδιά:
anticoagulant agent; antivitamin K; rivaroxaban, adult; all cause mortality; anticoagulant therapy; anticoagulation; artery bypass; assisted circulation; basic science; blood clotting; blood clotting disorder; clinical article; clinical practice; comparative study; controlled study; dual antiplatelet therapy; extracorporeal oxygenation; female; general practice; health care quality; heart failure; heart graft; heart left ventricle ejection fraction; heart output; heart transplantation; human; human cell; immunosuppressive treatment; male; medical history; percutaneous coronary intervention; peripheral circulation; prevalence; reduction (chemistry); Review; risk factor; shear stress; social media; thrombocyte activation; transcatheter aortic valve implantation; atrial fibrillation; blood clotting disorder; cerebrovascular accident; complication; heart arrhythmia; heart failure; heart left ventricle function; heart stroke volume; lung embolism; thromboembolism, Anticoagulants; Arrhythmias, Cardiac; Atrial Fibrillation; Blood Coagulation Disorders; Heart Failure; Humans; Pulmonary Embolism; Stroke; Stroke Volume; Thromboembolism; Ventricular Function, Left
DOI:
10.1016/j.cardfail.2022.12.012
