In patients with advanced heart failure followed for 5 years, coagulation disorders were highly prevalent, including 64.6% testing positive for HIT antibodies, and influenced adverse events.
Cohort (n=113)
Patients with advanced heart failure exhibit significant coagulation dysregulation, including a high prevalence of HIT antibodies and declining fibrinogen, which impact long-term thrombotic and bleeding risks.
Abstract Background/Introduction Patients with advanced heart failure (HF) present a complex clinical profile, including significant coagulation abnormalities, which pose a major challenge in patient management. According to ESC guidelines, optimizing pharmacotherapy and selecting the most appropriate advanced treatment strategies requires careful evaluation of haemostatic abnormalities. Understanding the interplay between heart failure progression and coagulation dysregulation is essential for improving patient outcomes, a key focus of this study. Purpose This study aimed to characterize the clinical profile of patients with advanced heart failure and assess the prevalence and impact of coagulation disorders in this population. The research focused on identifying predictors of thromboembolic and haemorrhagic events in long-term follow-up to guide individualized anticoagulation strategies. Methods A total of 113 patients with end-stage heart failure were prospectively enrolled and followed for five years. Patients were evaluated at baseline, 3-4 months, 6-12 months, and 5-year follow-up. The study included: Comprehensive clinical assessment based on ESC heart failure classification, including NYHA functional class, INTERMACS profile, and echocardiographic parameters. Coagulation profile analysis. Assessment of adverse events, including thromboembolic complications, bleeding events, and mortality. A detailed characterization of the study population is provided in Table 1 Results Among the 113 patients, 90.6% were male. The majority of heart failure had an ischemic aetiology, which was found in 57.6% of cases. Median NYHA class (4 3,5-4), INTERMACS classification (3 2–4), and left ventricular ejection fraction (15% 11–17%), highlight the severity of heart failure in study group. The most important comorbidities were hypertension (44,7%) and diabetes (41,2%). Key findings among others included: High vWF levels were noted in a significant proportion of patients, suggesting endothelial dysfunction secondary to advanced HF. Surprisingly, a substantial subset of patients tested positive for HIT antibodies (64,6%), necessitating individualized anticoagulation strategies. Fibrinogen levels showed a significant and progressive decline across time points suggesting a possible link with evolving coagulation dynamics in advanced HF Thrombotic events and major bleeding complications were significantly influenced by coagulation parameters. Conclusion This study highlights the critical role of coagulation disorders in the management of advanced heart failure. Long-term follow-up data suggest that individualized anticoagulation strategies based on laboratory markers and clinical risk stratification can help optimize patient outcomes, reduce thromboembolic complications and minimize bleeding risks. These findings highlight the necessity for personalized therapeutic approaches in patients undergoing advanced HF treatments.Table 1
Kuczaj et al. (Sat,) conducted a cohort in advanced heart failure (n=113). Coagulation disorders was evaluated on Thrombotic events, major bleeding complications, and mortality. In patients with advanced heart failure followed for 5 years, coagulation disorders were highly prevalent, including 64.6% testing positive for HIT antibodies, and influenced adverse events.