Congestive heart failure and thrombosis: Difference between revisions
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Revision as of 14:04, 20 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
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.[1] [2] [3]
Year | Event |
1950s | Prognosis appeared better in Anticoagulated 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, and its evident that Heart failure is often accompanied by hypercoaguble state[4] [5] [6].
Thrombus formation | |||||||||||||||||||||||||
Abnormal blood flow (Blood Stasis) | Abnormal blood constituents | Abnormal blood vessel wall | |||||||||||||||||||||||
In Heart failure, several factors come into play,
- Firstly
- Akinetic ventricular segments
- Dilated ventricular chambers,
- Dilated atria
with stagnant flow may increase thrombus formation[7].
- Secondly endothelial dysfunction which occur in heart failure, may impair the antithrombotic function of the endothelium[8].
- Thirdly, elevated levels of
- d-dimer,
- Beta-thromboglobulin,
- von Willebrand factor have been observed[6].
The prothrombotic stage[9] is further enhanced by
- Activated renin-angiotensin-aldosterone system (RAAS)
- Sympathetic nervous system,
- Systemic inflammation.
Epidemiology
Heart failure is the most frequent cause of hospitalization in patient aged 65 and above.[10] Heart failure is one of the most important public health problems, affecting an approximate half million patients in United States, with more than 550,000 new cases each year, and many more worldwide[11][4].
The incidence is expected to increase further in the next two decade as more number of people are surviving after myocardial infarction[12].
Natural History, Complications & Prognosis
Death is the ultimate complication that can happen in heart failure patients having thrombosis. In the ATLAS (Assessment of Treatment with Lisinopril and Survival) trial[13], there were many Heart failure patients who underwent autopsy, providing an unique opportunity and answering many questions about the cause of death.
Cause of death in autopsied Heart failure patients: ATLAS Trial
Condition | Percentage (%) |
---|---|
No specific pathology (presumed arrhythmic death) | 50.6 |
Myocardial infarction | 42.1 |
Other Cardiovascular cause | 4.8 |
Non-cardiac | 2.4 |
Cause of death in Heart failure: SOLVD Trial
Condition | Percentage (%) |
---|---|
Pump failure | 49 |
Sudden death | 23 |
Myocardial infarction | 12 |
Non-cardiac | 13 |
Fatal stroke or Pulmonary embolism | 3* |
Treatment
Rationale for Antithrombotic therapy in Heart failure
- Prevention of Stroke[15],
- Prevention of Systemic or Pulmonary embolism,
- Prevention of coronary thrombosis,
- Retarding progression of Heart failure.
- Increase survival.
Supportive Trial Data
The following Table shows the comparative data from various studies, each showing the probability of a thromboembolic events in Heart Failure patients.
Study | Year | Patients (n) | Follow-up (y) | NYHA Class | CVA | MI | PE | TTE |
---|---|---|---|---|---|---|---|---|
SAVE[16] | 1997 | 2231 | 3.5 | NR | 1.5 | NR | NR | NR |
SOLVD[17] | 1997 | 6796 | 3.3 | I-III | 1.1 | NR | NR | 1.6 |
WASH) 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.
Current GuidelinesEuropean Society of Cardiology[11]
ACC/AHA[20]
See alsoReferences
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