Anticoagulation in the cardiac patient: A concise review

Larson, Elise A.; German, David; Shatzel, Joseph J.; DeLoughery, Thomas G.

doi:10.1111/ejh.13171

Cited by 14 publications

(15 citation statements)

References 98 publications

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“…HF patients are often at increased risk of both thrombotic and bleeding events due to the complex interplay of underlying pathophysiological mechanisms, comorbidities, and concomitant medications [2,10]. The decision to initiate anticoagulation therapy in HF patients requires careful consideration of individual patient characteristics, including thrombotic and bleeding risks, as well as patient preferences and values [15]. Thromboembolic events, such as stroke and systemic embolism, are major causes of morbidity and mortality in HF patients, particularly those with concomitant AF or other thrombotic risk factors [16].…”

Section: Balancing Risks and Benefitsmentioning

confidence: 99%

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Saeed,

Fuenmayor,

Niño Medina

et al. 2024

Cureus

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Heart failure (HF) patients frequently present with comorbidities such as atrial fibrillation (AF) or other cardiovascular conditions, elevating their risk of thromboembolic events. Consequently, anticoagulation therapy is often considered for thromboprophylaxis, although its initiation in HF patients is complicated by concomitant bleeding risk factors. This review explores the paradoxical relationship between HF, increased bleeding risk, and the potential benefits of anticoagulation. Through an examination of existing evidence from clinical trials, observational studies, and meta-analyses, we aim to elucidate the role of anticoagulation in HF patients with increased bleeding risk. Despite guidelines recommending anticoagulation for certain HF patients with AF or other thromboembolic risk factors, uncertainty persists regarding the optimal management strategy for those at heightened risk of bleeding. The review discusses the pathophysiological mechanisms linking HF and thrombosis, challenges in bleeding risk assessment, and strategies to minimize bleeding risk while optimizing thromboprophylaxis. Shared decision-making between clinicians and patients is emphasized as essential for individualized treatment plans that balance the potential benefits of anticoagulation against the risk of bleeding complications. Furthermore, it examines emerging anticoagulant agents and their potential role in HF management, highlighting the need for further research to delineate optimal management strategies and inform evidence-based practice. In conclusion, while anticoagulation holds promise for improving outcomes in HF patients, careful consideration of patient-specific factors and ongoing research efforts are essential to optimize therapeutic strategies in this population.

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Section: Balancing Risks and Benefitsmentioning

confidence: 99%

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Saeed,

Fuenmayor,

Niño Medina

et al. 2024

Cureus

View full text Add to dashboard Cite

show abstract

“…Patients maintained on warfarin therapy need continuous monitoring of the INR to ensure that the anticoagulation is within the therapeutic range. Dauphin [138,139]. Zhu et al similarly studied an internet-based INR monitoring system in which patients can use telehealth to track INR and compared it to a control group using conventional INR monitoring through laboratories.…”

Section: Efficacy Of Different Anticoagulant Regiments With Mechanica...mentioning

confidence: 99%

Management of Intracranial Hemorrhage in the Setting of Mechanical Heart Valve Replacement Therapy

2023

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The management of an intracranial hemorrhage in patients receiving anticoagulant therapy presents a significant challenge for medical professionals. Anticoagulant treatment is intended to prevent blood clotting, but it can worsen active brain bleeds. Despite this risk, avoiding the prothrombotic state caused by mechanical heart valves remains crucial. Guidelines on managing this issue are currently lacking, prompting a review that delves into embryonic development and anatomical functions of heart valves, valve replacement therapy for diseased valves, and the need for anticoagulants. Ultimately, recent literature and cases inform discussion regarding how best to manage intracranial hemorrhages in patients with mechanical heart valves. The expectation is that this examination will offer valuable perspectives on the handling of intracranial bleeding among individuals with mechanical heart valves and stimulate additional investigations in this intricate domain, particularly through the lens of applied mechanics.

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“…Other therapies include antiplatelet agents, factor Xa inhibitors, and direct thrombin inhibitors or combinations (i.e., aspirin and clopidogrel). Patients who are unable to receive anticoagulation therapy can alternatively undergo interventions, such as left appendage occlusion 130 . Adipose‐released factors can stimulate prothrombotic pathways 131 .…”

Section: Af Treatmentmentioning

confidence: 99%

Updates on epicardial adipose tissue mechanisms on atrial fibrillation

et al. 2021

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Summary Obesity is a well‐known risk factor for atrial fibrillation (AF). Local epi‐myocardial or intra‐myocardial adiposity caused by aging, obesity, or cardiovascular disease (CVD) is considered to be a better predictor of the risk of AF than general adiposity. Some of the described mechanisms suggest that epicardial adipose tissue (EAT) participates in structural remodeling owing to its endocrine activity or its infiltration between cardiomyocytes. Epicardial fat also wraps up the ganglionated plexi that reach the myocardium. Although the increment of volume/thickness and activity of EAT might modify autonomic activity, autonomic system dysfunction might also change the endocrine activity of epicardial fat in a feedback response. As a result, new preventive therapeutic strategies are focused on reducing adiposity and weight loss before AF ablation or inhibiting autonomic neurotransmitter secretion on fat pads during open‐heart surgery to reduce the recurrence or postoperative risk of AF. In this manuscript, we review some of the novel findings regarding the pathophysiology and associated risk factors of AF, with special emphasis on the role of EAT in the electrical, structural, and molecular mechanisms of AF initiation and maintenance. In addition, we have included a brief note provided on epicardial fat preclinical models that could be useful for identifying new therapeutic targets.

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Anticoagulation in the cardiac patient: A concise review

Cited by 14 publications

References 98 publications

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Unraveling the Paradox: Can Anticoagulation Improve Outcomes in Patients With Heart Failure and Increased Bleeding Risk?

Management of Intracranial Hemorrhage in the Setting of Mechanical Heart Valve Replacement Therapy

Updates on epicardial adipose tissue mechanisms on atrial fibrillation

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