Antithrombotic therapy for congestive heart failure

Chung, Irene; Lip, Gregory Y.H.

doi:10.1111/j.1368-5031.2005.00676.x

Cited by 10 publications

(10 citation statements)

References 116 publications

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“…Heart failure is associated with a prothrombotic state,1–4 although the beneficial effect of antithrombotic treatment in patients with HF has not been clearly established. This may be the result of the low incidence of arterial or venous thrombo‐embolic events in these patients, or the risk of bleeding associated with this medication 3.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Heart failure (HF) is associated with a prothrombotic state, resulting in an increased risk for both arterial and venous thrombo‐embolic events 1–4. The annual incidence of thrombo‐embolic events in patients with HF is estimated to be 1.5–3.5% 1. The relation between HF and a prothrombotic state is supported by the observation of platelet hyperactivity, increased thrombin generation, and impaired fibrinolysis 5,6.…”

Section: Introductionmentioning

confidence: 99%

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Non‐selective vs. selective beta‐blocker treatment and the risk of thrombo‐embolic events in patients with heart failure

Peuter

Souverein

Klungel

et al. 2011

European J of Heart Fail

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AimsHeart failure (HF) is associated with a prothrombotic state, resulting in an increased risk for thrombo-embolic events. Studies suggest a reduced prothrombotic state when non-selective beta-blockers relative to selective beta-blockers are given. We studied the influence of non-selective beta-blockers compared with selective beta-blockers on the occurrence of arterial and venous thrombo-embolic events in patients with HF. Methods and resultsData were obtained from the PHARMO Record Linkage System, a population-based registry of pharmacy records linked with hospital discharge records in The Netherlands. In the period of 1998-2007, 20 870 patients were hospitalized for HF. We used Cox regression analysis with time-varying beta-blocker covariate to assess the difference in the incidence of thrombo-embolic events [acute coronary syndrome (ACS), stroke, or pulmonary embolism] among patients. Median follow-up was 2.0 years (inter-quartile range: 0.7 -4.1). Directly after discharge, 6558 patients were prescribed a selective beta-blocker and 2202 patients a non-selective beta-blocker. The hazard ratio (HR) for any thrombo-embolic event for non-selective beta-blockers compared with selective beta-blockers was 0.76 [95% confidence interval (CI): 0.64-0.89]. After adjustment, the difference remained (HR 0.84, 95% CI: 0.72-0.99). The effect was most prominent for ACS (HR 0.78, 95% CI: 0.65-0.93), and not clear for stroke (HR 1.00, 95% CI: 0.67-1.50) or pulmonary embolism (HR 1.33, 95% CI: 0.66-2.71). ConclusionIn patients with HF, the use of non-selective beta-blockers was associated with a lower risk of thrombo-embolic events than selective beta-blockers. Whether this beneficial effect is caused by the additional beta2-receptor blockade remains to be elucidated. These findings need to be validated in a well-designed randomized study.--

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Non‐selective vs. selective beta‐blocker treatment and the risk of thrombo‐embolic events in patients with heart failure

Peuter

Souverein

Klungel

et al. 2011

European J of Heart Fail

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“…Of note, no relationship between the risk of embolization and the presence of atrial fibrillation or the presence of LV thrombus was observed. Generally, post hoc analyses of large clinical trials of heart failure treatment have reported a somewhat lower stroke incidence when compared with relatively smaller prospective studies, with annual stroke rates in range of 1.0-4.5% [26,27]. In a retrospective analysis of the Study of Left Ventricular Dysfunction (SOLVD) trial [28], the annual rate of thromboembolic events was 2.4% in women and 1.8% in men, with lower EF contributing to higher thromboembolic events in women but not in men, and this difference was mainly driven by an excess of pulmonary embolism.…”

Section: Search Strategymentioning

confidence: 99%

Antithrombotic therapy for heart failure in sinus rhythm

Subramaniam

Davis

Shantsila

et al. 2009

Fundamemntal Clinical Pharma

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Although the risk of thromboembolism in chronic heart failure is high even in the absence of atrial fibrillation, the risk to benefit ratio of anticoagulation vs. antiplatelet therapy or no antithrombotic therapy is poorly defined in this population. Post hoc analysis of large therapeutic heart failure trials has estimated the risk of thromboembolism to be between 1 and 4.5%. However, most of these studies have included some patients with atrial fibrillation, and thromboembolism was not a predefined endpoint. At present, the evidence for either anticoagulation or antiplatelet therapy is limited and the results from current large‐scale randomized studies are awaited. From the randomized studies carried out thus far, there is a beneficial trend in favour of anticoagulation therapy, with less hospitalization for heart failure compared with patients taking aspirin.

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“…Although a number of studies have focused on AF in patients with heart failure and MI little is known about the incidence of new-onset AF following hospitalization in these populations [3,4]. Knowledge of this is important as it may influence the risk of thromboembolism and stroke and the potential benefit of antiarrhythmic treatment [5,6]. Due to lack of data on this matter, an expert panel appointed by The National Heart, Lung and Blood Institute has recently strongly recommended further research in AF prevention [7].…”

Section: Introductionmentioning

confidence: 99%

Incidence of Atrial Fibrillation in Patients with either Heart Failure or Acute Myocardial Infarction and Left Ventricular Dysfunction: A Cohort Study

Schmiegelow

Pedersen

Køber

et al. 2011

BMC Cardiovasc Disord

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BackgroundWe examined the incidence of new-onset atrial fibrillation in patients with left ventricular dysfunction. Patients either had a recent myocardial infarction (with or without clinical heart failure) or symptomatic heart failure (without a recent MI). Patients were with and without treatment with the class III antiarrhythmic drug dofetilide over 36 months.MethodsThe Danish Investigations of Arrhythmia and Mortality ON Dofetilide (DIAMOND) studies included 2627 patients without atrial fibrillation at baseline, who were randomised to treatment with either dofetilide or placebo.ResultsThe competing risk analyses estimated the cumulative incidences of atrial fibrillation during the 42 months of follow-up to be 9.6% in the placebo-treated heart failure-group, and 2.9% in the placebo-treated myocardial infarction-group.Cox proportional hazard regression found a 42% significant reduction in the incidence of new-onset AF when assigned to dofetilide compared to placebo (hazard ratio 0.58, 95% confidence interval 0.40-0.82) and there was no interaction with study (p = 0.89).In the heart failure-group, the incidence of atrial fibrillation was significantly reduced to 5.6% in the dofetilide-treated patients (hazard ratio 0.57, 95% confidence interval 0.38-0.86).In the myocardial infarction-group the incidence of atrial fibrillation was reduced to 1.7% with the administration of dofetilide. This reduction was however not significant (hazard ratio 0.61, 95% confidence interval 0.30-1.24).ConclusionIn patients with left ventricular dysfunction the incidence of AF in 42 months was 9.6% in patients with heart failure and 2.9% in patients with a recent MI. Dofetilide significantly reduced the risk of developing atrial fibrillation compared to placebo in the entire study group and in the subgroup of patients with heart failure. The reduction in the subgroup with recent MI was not statistically significant, but the hazard ratio was similar to the hazard ratio for the heart failure patients, and there was no difference between the effect in the two studies (p = 0.89 for interaction).

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Antithrombotic therapy for congestive heart failure

Cited by 10 publications

References 116 publications

Non‐selective vs. selective beta‐blocker treatment and the risk of thrombo‐embolic events in patients with heart failure

Non‐selective vs. selective beta‐blocker treatment and the risk of thrombo‐embolic events in patients with heart failure

Antithrombotic therapy for heart failure in sinus rhythm

Incidence of Atrial Fibrillation in Patients with either Heart Failure or Acute Myocardial Infarction and Left Ventricular Dysfunction: A Cohort Study

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