Should Heart Failure Be Treated with Antithrombotic Drugs?

Congestive heart failure (CHF) is increasing in prevalence in Western society and is associated with considerable morbidity and mortality, including a high risk of venous thromboembolism and stroke. In addition, up to 50% of CHF sufferers die of sudden cardiac death, of which a major mechanism may be thrombotic coronary occlusion leading to myocardial infarction. Thus, antithrombotic therapy would be expected to provide a substantial morbidity and mortality benefit to these patients. However, clinical evidence to support this hypothesis is limited and inconsistent. Aspirin is routinely used in patients with CHF secondary to ischaemic heart disease; however, as yet, no randomised trials of long-term aspirin therapy in CHF have been reported. Since warfarin therapy is associated with a definite risk of bleeding, anticoagulation should be considered only on a case-by-case basis for patients with CHF and additional risk factors (including atrial fibrillation, previous thromboembolic stroke and mural thrombus formation) until more definitive evidence is available.