Congestive heart failure and thrombosis: Difference between revisions
Jump to navigation
Jump to search
No edit summary |
No edit summary |
||
| Line 57: | Line 57: | ||
**Hospitalization for heart failure was significantly greater in [[aspirin]]-treated patients than in [[warfarin]]-treated patients. | **Hospitalization for heart failure was significantly greater in [[aspirin]]-treated patients than in [[warfarin]]-treated patients. | ||
====ACC/AHA==== | ====ACC/AHA<ref name="pmid19358937">{{cite journal| author=Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG et al.| title=2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. | journal=J Am Coll Cardiol | year= 2009 | volume= 53 | issue= 15 | pages= e1-e90 | pmid=19358937 | doi=10.1016/j.jacc.2008.11.013 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19358937 }} </ref>==== | ||
*[[Anticoagulant]]s should be considered in | *[[Anticoagulant]]s should be considered in | ||
**Patients with heart failure having prior history of VTE. | **Patients with heart failure having prior history of VTE. | ||
Revision as of 23:46, 3 October 2011
Editors-in-Chief: C. Michael Gibson, M.S., M.D. Associate Editor-In-Chief: Ujjwal Rastogi, MBBS [1]
|
Thrombosis Microchapters |
|
Site of Thrombosis |
|---|
|
Differentiating Thrombosis from other Diseases |
|
Diagnosis |
|
Treatment |
|
Congestive heart failure and thrombosis On the Web |
|
to Hospitals Treating Congestive heart failure and thrombosis |
|
Risk calculators and risk factors for Congestive heart failure and thrombosis |
Overview
Heart failure is one of the most important public health problems, afflicting an approximate half million patients in United States, with more than 550,000 new cases each year, and many more worldwide[1][2]. CHF results when heart is not able to meet the demands of circulation causing insufficient blood flow. These patients are at higher risk of arterial and venous thrombosis.
Historical Perspective
Throughout history many renowned researchers and health care professionals have contributed to the understanding, definition, and recognition of thrombosis in Heart Failure patients.[3] [4] [5]
| Year | Event |
| 1950s | Prognosis appeared better in Anticouagulated patient. |
| 1960s - 1970s | Retrospective analysis and Autopsy findings showed thromboembolism as an etiology. |
| 1980s - 1990s | Better understanding of hypercoaugubilty in Heart failure patients. |
| 2000- | Role of Aspirin in heart failure patients is studied. |
Pathophysiology
Stagnation of blood flow, disorder in vascular wall, and blood coagulation system are known factors that participate in the thrombosis formation.
Treatment
Rationale for Antithrombotic therapy in Heart failure
- Prevention of Stroke[6],
- Prevention of Systemic or Pulmonary embolism,
- Prevention of coronary thrombosis,
- Retarding progression of Heart failure.
- Increase survival.
Supportive Trial Data
- The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH[7]) trial was the first modern RCT to study warfarin in patients with heart failure. The trial showed a reduction of nonfatal stroke events with warfarin over aspirin or clopidogrel.
- In the ARixtra for ThromboEMbolISm prevention in a medical indications study (ARTEMIS[8]) trial in acutely ill medical patients, fondaparinux significantly reduced the risk of total venous thromboembolism, without increasing bleeding risk compared with placebo.
- In the Survival and Ventricular Enlargement (SAVE[9]) Trial,which enrolled patients with left ventricular dysfunction after MI, the VTE annual rate (fatal and nofatal stroke) was 1.5%.
Current Guidelines [1]
European Society of Cardiology
- Anticoagulants have shown to be more effective than antiplatelet agents in reducing the risk of stroke; thus they are preferred agents in
- patients with more than one risk factors, like
- In patients with Heart failure and Atrial fibrillation lacking any other additional risk factors., to prevent primary VTE event.
- With respect to Antiplatelet agents,
- They are found to be less efficacious than anticougulants, in preventing a VTE event in patients with Atrial fibrillation, .
- Hospitalization for heart failure was significantly greater in aspirin-treated patients than in warfarin-treated patients.
ACC/AHA[10]
- Anticoagulants should be considered in
- Patients with heart failure having prior history of VTE.
- Patients having paroxysmal or persistant Atrial fibrillation.
- Patients with other co-morbidity, which increases the risk for VTE.
- Patients with familial dilated cardiomyopathy and a history of VTE in first-degree relatives.
- With respect to Antiplatelet agents, it should be used in:
- Myocardial infarction.
- Heart failure patients with known history of coronary artery disease.
- However, ACC/AHA has stated that
- Role of aspirin in heart failure is still not established.
- Aspirin may attenuate the hemodynamic and survival benefits of ACE inhibitors.
See also
References
- ↑ 1.0 1.1 Task Force for Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of European Society of Cardiology. Dickstein K, Cohen-Solal A, Filippatos G, McMurray JJ, Ponikowski P; et al. (2008). "ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM)". Eur Heart J. 29 (19): 2388–442. doi:10.1093/eurheartj/ehn309. PMID 18799522.
- ↑ Massie BM, Shah NB (1997). "Evolving trends in the epidemiologic factors of heart failure: rationale for preventive strategies and comprehensive disease management". Am Heart J. 133 (6): 703–12. PMID 9200399.
- ↑ WISHART JH, CHAPMAN CB (1948). "Dicumarol therapy in congestive heart failure". N Engl J Med. 239 (19): 701–4. doi:10.1056/NEJM194811042391902. PMID 18892580.
- ↑ HARVEY WP, FINCH CA (1950). "Dicumarol prophylaxis of thromboembolic disease in congestive heart failure". N Engl J Med. 242 (6): 208–11. doi:10.1056/NEJM195002092420603. PMID 15403339.
- ↑ GRIFFITH GC, STRAGNELL R, LEVINSON DC, MOORE FJ, WARE AG (1952). "A study of the beneficial effects of anticoagulant therapy in congestive heart failure". Ann Intern Med. 37 (5): 867–87. PMID 12986600.
- ↑ Kannel WB, Wolf PA, Verter J (1983). "Manifestations of coronary disease predisposing to stroke. The Framingham study". JAMA. 250 (21): 2942–6. PMID 6227757.
- ↑ Massie BM, Krol WF, Ammon SE, Armstrong PW, Cleland JG, Collins JF; et al. (2004). "The Warfarin and Antiplatelet Therapy in Heart Failure trial (WATCH): rationale, design, and baseline patient characteristics". J Card Fail. 10 (2): 101–12. PMID 15101020.
- ↑ Cohen AT, Davidson BL, Gallus AS, Lassen MR, Prins MH, Tomkowski W; et al. (2006). "Efficacy and safety of fondaparinux for the prevention of venous thromboembolism in older acute medical patients: randomised placebo controlled trial". BMJ. 332 (7537): 325–9. doi:10.1136/bmj.38733.466748.7C. PMC 1363908. PMID 16439370.
- ↑ St John Sutton M, Pfeffer MA, Moye L, Plappert T, Rouleau JL, Lamas G; et al. (1997). "Cardiovascular death and left ventricular remodeling two years after myocardial infarction: baseline predictors and impact of long-term use of captopril: information from the Survival and Ventricular Enlargement (SAVE) trial". Circulation. 96 (10): 3294–9. PMID 9396419.
- ↑ Hunt SA, Abraham WT, Chin MH, Feldman AM, Francis GS, Ganiats TG; et al. (2009). "2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation". J Am Coll Cardiol. 53 (15): e1–e90. doi:10.1016/j.jacc.2008.11.013. PMID 19358937.