Reduced cardiac function and risk of venous thromboembolism in Asian countries

Abstract

Patients with reduced cardiac function are thought to have a higher risk of venous thromboembolism (VTE). Additionally, they are vulnerable to complications of pulmonary embolism (PE) as well as right heart failure (HF), which in return is supposed to increase the rate of mortality. Studies focusing on VTE in heart failure patients were rare in Asian countries before the 21st century. Nowadays, more and more data are becoming available in this field in Asia. It is already known that heart failure can increase the risk of VTE, but so far a consensus on this issue has not been reached for many years, not only in Asian countries but all over the world. This condition may be due to the detailed pathological advancement in Virchow’s triad and some other theories. In clinical practice, VTE, especially PE is difficult to diagnose in patients with heart failure because of overlapping symptoms (e.g. cough and chest pain) and the elevation of laboratory markers (e.g. probrain natriuretic peptide (NT-proBNP) and D-dimer in both heart failure and VTE patients). Management of VTE in heart failure patients is also controversial because heart failure patients always have complications, such as renal failure and hepatic failure, which increase the risk of bleeding. In this study, we analyzed data from China, Japan, Korea, Singapore and India mainly to get a better understanding of the research progress in VTE in patients with heart failure. The aim of this review is to discuss the risk, incidence, advancement of diagnosis, management and prevention of VTE in patients with heart failure in Asian countries.

The risk of venous thromboembolism in patients with heart failure

“…Основными патогенетическими механизмами повышения риска ВТЭО у госпитализированных пациентов с сердечно-сосудистой патологией могут быть эндотелиальное повреждение и эндотелиальная дисфункция, нарушение работы антикоагулянтной системы протеина С при повышенной концентрации в плазме провоспалительных цитокинов (интерлейкин-6, фактор некроза опухоли и др. ), активация PAR-рецепторов, стаз крови в условиях снижения сердечного выброса, повреждение тканей с экспрессией тканевого фактора, запускающего коагуляционный каскад, замедление фибринолиза [10]. Дополнительными факторами риска ВТЭО при ХСН могут являться: пожилой возраст, иммобилизация, инфекции, частое использование центральных венозных катетеров, имплантация электрокардиостимуляторов и дефибрилляторов, усугубляющих риск инфекционных осложнений и, в целом, формирование протромботического статуса.…”

Healing Rates of Venous Leg Ulcer Using Four Layer Bandage and Short Stretch Bandage- A Comparative Study in Aspect of Bangladesh

“…The exact cause of venous ulcers is not certain, but a common denominator is generally venous stasis, which may be caused by chronic venous insufficiency, and/or congestive heart failure. 20,21 Venous stasis causes the pressure in veins to increase. The body needs the pressure gradient between arteries and veins in order for the heart to pump blood forward through arteries and into veins.…”

“…23 Allowing blood to flow back into the limb, for example by elevating it, is necessary but also contributes to reperfusion injury. 20 Other comorbidities may also be the root cause of venous ulcers. 21 It is in the crus that the classic venous stasis ulcer occurs.…”

Elevated D‐dimer levels predict adverse outcomes in hospitalised elderly patients with chronic heart failure

“…In addition, D‐dimer is as a fibrin degradation product; hence, it is relatively commonly used in the diagnostic tree for DVT, and even as a marker in the follow up of PTE. However, reduced cardiac function is considered an intermediate risk factor for venous thromboembolism, including DVT and PTE, which are associated with worse outcomes of heart failure. In our study, the D‐dimer level was found to be a better predictor of all‐cause death in patients with HFPEF than in patients with HFREF, partly because more patients with HFPEF also had atrial fibrillation (AF) .…”