Antithrombotics in Heart Failure With Reduced Ejection Fraction and Normal Sinus Rhythm

Abstract

Current evidence does not support the routine use of antithrombotics for preventing thromboembolic events in patients with HFrEF-NSR without compelling indications.

Left atrial appendage closure in patients with a reduced left ventricular ejection fraction: results from the multicenter German LAARGE registry

“…Such a low rate of thromboembolism was reached although patients with severely impaired LV myocardium were not anticoagulated to a higher extent after the procedure, neither did they present with a higher percentage of prior strokes at baseline. These findings could extend the evidence that OAC is dispensable in those patients with regard to LV thromboembolism [ 10 , 15 ]. Though one must bear in mind that the present results are limited to one year, and thromboembolic complications might occur later on.…”

Coexisting Cardiac and Hematologic Disorders

“…Baseline warfarin use has been associated with a reduction in all-cause mortality and acute coronary syndrome; however, the rate of major bleeding is increased when compared with aspirin or clopidogrel 49 . Antiplatelet and antithrombotic use in patients with normal sinus rhythm and reduced ejection fraction should be dictated based upon underlying co-morbidities and heart failure pathology.…”

“…Multiple randomized controlled trials have compared the use of warfarin, aspirin, and clopidigrel in this patient population with conflicting results [46][47][48] . Aspirin has been associated with increased risk for hospitalization and gastrointestinal bleeding; however, this may be due to an as yet undefined interaction with ACE inhibitors 49 .…”

Asia Pacific Stroke Conference 2015 Abstracts of the Annual Conference of the Asia Pacific Stroke Organization (APSO) Kuala Lumpur, Malaysia, October 2-4, 2015: Abstracts

“…Many guidelines and reviews have advocated the use of oral vitamin K antagonist in CM associated with AF (Oliphant et al, 2013). However, the consensus of anticoagulation use in CM without arrhythmia is not yet established (Prom et al, 2014). The role of NOACs is still under investigation.…”