Does anticoagulation therapy improve outcomes in severe heart failure with reduced ejection fraction? A systematic review

Background: Heart failure with reduced ejection fraction (HFrEF) is a growing health concern, with an increased risk of thromboembolic events. Oral anticoagulants (OACs) are commonly used in HFrEF patients with atrial fibrillation, but their role in patients with sinus rhythm is unclear. Objective: To assess the safety and efficacy of OACs in HFrEF patients with sinus rhythm. Methods: A systematic review of seven studies involving 17 051 patients was conducted. Outcomes included mortality, nonfatal myocardial infarction (MI), nonfatal stroke, and hospitalization rates. Results: OACs significantly reduced non-fatal strokes compared to antiplatelets and placebo. A measurable reduction in nonfatal MIs was observed in most studies. However, no conclusive benefit was found regarding all-cause fatality and rehospitalization rates. The benefit of OACs in stroke prevention was counterbalanced by an increased risk of major bleeding episodes. Conclusion: OACs may have a role in reducing nonfatal cardiovascular events in HFrEF patients with sinus rhythm, particularly those with ischemic etiologies or underlying thrombotic states. However, further research is needed to establish their efficacy and safety in this population.