Bayer Pharma AG


Guidelines for anticoagulation therapy in patients with heart failure

Guidelines for anticoagulation therapy in patients with heart failure

There are few specific guidelines for patients with heart failure owing to a lack of venous thromboembolism (VTE) prophylaxis data. However, a number of guidelines on the use of thromboprophylaxis in hospitalized patients have been developed by the ACCP, ESC, ACC/AHA, IUA and NICE. Guidelines on stroke prevention in patients with atrial fibrillation (AF) are also relevant for patients with heart failure because this is a closely associated condition.


A Major Risk Factor for VTE

Heart failure is an independent and major risk factor for venous thromboembolism (VTE), and coronary artery disease is a major cause of heart failure. Patients with heart failure who develop VTE have a worse prognosis relative to patients without the condition, and those who undergo hospitalization have an even greater risk of VTE. Both deep vein thrombosis (DVT) and pulmonary embolism (PE) are associated with significant mortality and morbidity in this population. The use of pacemakers, implantable defibrillators and central venous catheters are also linked to increased VTE risk.


Anticoagulation of patients with heart failure

Limited data are available regarding anticoagulation therapy in patients with heart failure, and to date there have been no large studies that have evaluated antithrombotic prophylaxis specifically in patients with heart failure. Results from the WARCEF study showed that warfarin reduced the rate of ischaemic stroke relative to acetylsalicylic acid (ASA; aspirin). However, this benefit was offset by a higher risk of bleeding. Given these findings, the authors suggested that the choice between warfarin and ASA should be individualized based on each patient’s specific circumstances. Anticoagulant therapy for patients with coronary artery disease and heart failure is under investigation.


The risk of stroke is increased in patients with heart failure

Heart failure is an independent and major risk factor for venous thromboembolism (VTE). Patients with heart failure who develop VTE have a worse prognosis relative to patients without the condition and those who undergo hospitalization have an even greater risk of VTE. Both deep vein thrombosis (DVT) and pulmonary embolism (PE) are associated with significant mortality and morbidity in this population. The use of pacemakers, implantable defibrillators and central venous catheters are also linked to increased VTE risk.


Heart failure and coronary artery disease

Coronary artery disease (CAD) is a major cause of chronic heart failure (HF). Breathlessness, ankle oedema and fatigue may be indicative of HF in patients with a history of CAD. Patients with CAD and HF are managed using a combination of drug therapy and lifestyle changes, and may be offered an implantable device. Patients with HF are at risk of thromboembolism. Anticoagulants are given to patients with atrial fibrillation who have HF, but there is a lack of evidence for use in patients with HF who have a normal sinus rhythm. The phase III COMMANDER HF study will assess rivaroxaban in patients with chronic HF and CAD.