Key result
DOACs match warfarin in efficacy and safety for stroke prevention in AF and HF.
Direct oral anticoagulants appear to have similar safety and efficacy profiles in patients with heart failure and atrial fibrillation as in those without heart failure, though patients with severe renal or hepatic dysfunction were excluded from major trials.
Supports similar DOAC profiles in HF-AF; leaves open questions for severe renal/hepatic impairment excluded from trials.
Heart failure (HF) with reduced left ventricular function inflicts a large and growing burden of morbidity and mortality in the US and across the globe. One source of this burden is stroke. While it appears that HF itself may impose some risk of stroke, it is in the presence of other risk factors, like atrial fibrillation, that the greatest risks are observed. Therapeutic anticoagulation is the mainstay of risk reduction strategies in this population. While warfarin was the only available therapy for anticoagulation for many decades, there are now four direct oral anticoagulants available. In three of these four, outcomes in the specific subgroup of patients with heart failure have been examined. In this review, we provide some pathophysiologic basis for the risk of stroke in heart failure. In addition, the available therapeutic options for stroke risk prevention in heart failure are described in detail including how these options are incorporated into relevant professional society guidelines.
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Zeitler et al. (2015) conducted a review in Heart Failure. Anticoagulation was evaluated. Direct oral anticoagulants demonstrate similar efficacy and safety to warfarin for stroke prophylaxis in patients with heart failure and atrial fibrillation, with no significant interaction based on heart failure status.
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