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Thrombo‐embolism and antithrombotic therapy for heart failure in sinus rhythm. A Joint Consensus Document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis
Author(s) -
Lip Gregory Y.H.,
Ponikowski Piotr,
Andreotti Felicita,
Anker Stefan D.,
Filippatos Gerasimos,
Homma Shunichi,
Morais Joao,
Pullicino Patrick,
Rasmussen Lars H.,
Marin Francisco,
Lane Deirdre A.,
Lip Gregory Y.H.,
Ponikowski Piotr,
Andreotti Felicita,
Anker Stefan D.,
Filippatos Gerasimos,
Homma Shunichi,
Morais Joao,
Pullicino Patrick,
Rasmussen Lars H.,
Marin Francisco,
Lane Deirdre A.,
McMurray John,
Hoes Arno,
Ten Berg Jurrien,
De Caterina Raffaele,
Kristensen Steen,
Zeymer Uwe
Publication year - 2012
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1093/eurjhf/hfs073
Subject(s) - medicine , heart failure , atrial fibrillation , cardiology , sinus rhythm , stroke (engine) , warfarin , ejection fraction , thrombosis , embolism , antithrombotic , intensive care medicine , mechanical engineering , engineering
Chronic heart failure (HF) with either reduced or preserved ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to HF can be related to thrombosis. Epidemiological and pathophysiological data also link HF to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thrombo‐embolism, and/or venous thrombo‐embolism. This consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence and summarizes ‘best practice’, and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation, oral anticoagulation is recommended, and the CHA 2 DS 2 ‐VASc and HAS‐BLED scores should be used to determine the likely risk–benefit ratio (thrombo‐embolism prevention vs. risk of bleeding) of oral anticoagulation. In HF patients with reduced left ventricular ejection fraction who are in sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Despite the potential for a reduction in ischaemic stroke, there is currently no compelling reason to use warfarin routinely for these patients. Risk factors associated with increased risk of thrombo‐embolic events should be identified and decisions regarding use of anticoagulation individualized. Patient values and preferences are important determinants when balancing the risk of thrombo‐embolism against bleeding risk. New oral anticoagulants that offer a different risk–benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.