Key result
Treatment with oral anticoagulants versus antiplatelets or placebo in heart failure patients with sinus rhythm has failed to improve primary morbidity and mortality outcomes.
Why the study?
How and who to treat to prevent a thromboembolic event in patients with heart failure and sinus rhythm remains an unresolved clinical issue.
Do oral anticoagulants or antiplatelet agents prevent thromboembolic events and improve morbidity/mortality in heart failure patients with sinus rhythm?
Do oral anticoagulants or antiplatelet agents prevent thromboembolic events and improve morbidity/mortality in heart failure patients with sinus rhythm?
Routine use of oral anticoagulants in heart failure patients with sinus rhythm is not currently supported, as the reduction in ischemic stroke is offset by an increased risk of major hemorrhage.
Does not support routine OAC use in HF with sinus rhythm; leaves open targeted trials on net benefit in high-stroke-risk subgroups.
Heart failure patients may have impaired cerebral autoregulation and regional cerebral blood flow abnormalities. Predisposition to thromboembolic complications occur because of dilated chambers and abnormal blood flow, abnormal vessel/chamber lining and abnormal blood particles in heart failure patients. Epidemiological and clinical studies document an increased rate of thromboembolic complications in heart failure. Well known/accepted indications of oral anticoagulation therapy to prevent thromboembolic events are co-existence of atrial fibrillation/flutter, intracardiac thrombi and a history of a thromboembolic event. Other than a co-existence of coronary artery disease and heart failure, antiplatelet agents should not be used in heart failure patients to prevent ischemic stroke. How and who to treat/prevent a thromboembolic event in patients with heart failure and sinus rhythm is a hot topic. Up to date, clinical studies of treatment with oral anticoagulant agents-mainly warfarin and recently rivaroxaban vs antiplatelet agents or placebo could not meet their primary outcome related with morbidity/mortality. In some of these studies, decreased rate of ischemic strokes were offset by increased major hemorrhage.
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Sayın et al. (2021) conducted a review in Heart failure. Oral anticoagulants (warfarin, rivaroxaban) vs. Antiplatelet agents or placebo was evaluated on Morbidity/mortality. Treatment with oral anticoagulants versus antiplatelets or placebo in heart failure patients with sinus rhythm has failed to improve primary morbidity and mortality outcomes.
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