Bayer Pharma AG

Essence of this Article

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.

Guidelines for anticoagulation therapy in patients with heart failure

Because of the lack of VTE prophylaxis data in patients with heart failure, there are few specific guidelines for these patients. However, a number of guidelines on the use of thromboprophylaxis in hospitalized patients, including those with New York Heart Association class III or IV chronic heart failure, have been developed by multiple national and international thrombosis and haemostasis societies. Guidelines on stroke prevention in patients with AF are also relevant for patients with heart failure because this is a closely associated condition.

Guidelines for anticoagulation therapy in patients with heart failure

Guideline Recommendation
American College of Chest Physicians (ACCP) 2012330 Thromboprophylaxis with UFH, LMWH or fondaparinux in acutely ill hospitalized medical patients with heart failure
European Society of Cardiology (ESC) 2012331 Thromboprophylaxis with: Oral anticoagulanta in patients with heart failure and AF
Intravenous heparin or LMWH in patients with heart failure who have not been treated with an anticoagulant and require urgent electrical or pharmacological cardioversion
American College of Cardiology/ American Heart Association (ACC/AHA) 2013332 Chronic anticoagulant thromboprophylaxis for patients with chronic heart failure and AF who also have ≥1 additional risk factor(s) for stroke; consider anticoagulation even if no additional risk factors are present
Oral anticoagulant choice (warfarin, rivaroxaban, dabigatran or apixaban) to be based on individual patient factors and preferences
Anticoagulation is not recommended for patients with chronic heart failure with reduced ejection fraction if they do not have AF
Heart Failure Society of America (HFSA) 2010333 Thromboprophylaxis with warfarin in:
  • Patients with heart failure and AF
  • Patients with heart failure and previous thromboembolism
  • Patients with heart failure and left ventricular thrombus


Long-term treatment with an antiplatelet agent:
  • Patients with heart failure caused by ischaemic cardiomyopathy
International Union of Angiology (IUA) 2006334 Thromboprophylaxis with UFH or LMWH for all acutely medically ill patients, including patients with heart failure
National Institute for Health and Care Excellence (NICE) 2012335 Thromboprophylaxis with fondaparinux, LMWH or UFH (for patients with renal failure) for general medical patients assessed to be at increased risk of venous thromboembolism (those with reduced mobility and one or more risk factors for venous thromboembolism, such as heart failure)
aWarfarin, direct thrombin inhibitor or direct Factor Xa inhibitor; if a non-warfarin oral agent is used, serial monitoring of renal function is required.
AF, atrial fibrillation; LMWH, low molecular weight heparin; UFH, unfractionated heparin.

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