Key result
Cardioembolic stroke and LV thrombus in HFrEF with sinus rhythm highlight gaps in anticoagulation consensus.
Why the study?
No consensus exists on the choice of anticoagulation and clinical criteria for its use in patients with HfrEF and sinus rhythm.
Case Report (n=1)
No
This case highlights the clinical dilemma and lack of consensus regarding the use of prophylactic anticoagulation in patients with HFrEF and sinus rhythm who are at high risk for cardioembolic stroke.
Answers are grounded in this paper and cite their sources.
Underscores anticoagulation uncertainty in HFrEF with sinus rhythm; leaves open prophylactic strategy pending trials.
Heart failure results in significant morbidity and mortality. Heart failure with reduced ejection fraction (HfrEF) in the absence of atrial fibrillation has been increasingly considered an independent risk factor for ischemic stroke, partly because of the development of left ventricular thrombus and subsequent cardioembolic stroke and partly because of hemodynamic impairment. Here, we present a case of a 60-year-old male with heart failure with reduced ejection fraction, who presented with cardioembolic ischemic stroke. In the investigation to localize the source, he was found to have slow intra-ventricular blood flow, which over shorter periods of follow up lead to the development of left ventricle intra-mural thrombi. Meanwhile, the patient also developed hemorrhagic conversion in the ischemic stroke, which further complicated the choice of anticoagulation. To date, no consensus has been developed on the choice of anticoagulation and clinical criteria for the use of anticoagulation in patients having HfrEF and sinus rhythm. This case brings forth a need for further research on whether anticoagulation would be beneficial in patients with HfrEF and sinus rhythm.
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Rasool et al. (2023) conducted a case report in Heart failure with reduced ejection fraction and sinus rhythm (n=1). Warfarin was evaluated. A 60-year-old male with heart failure with reduced ejection fraction and sinus rhythm developed a cardioembolic ischemic stroke and left ventricular thrombus, highlighting the lack of consensus on anticoagulation.
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