[Anticoagulation in primary prevention of thromboembolism in advanced left ventricular dysfunction].
BACKGROUND
Patients with heart failure have an increased risk for thromboembolic events. In clinical practice the physician is often confronted with the decision to establish a prophylactic anticoagulation.


METHODS
The incidence for clinical embolization is 1.5 to 3.5% per year. It seems that patients with a lower peak oxygen uptake and with a lower ejection fraction are at higher risk for embolic events. There is no evidence for a correlation of such events with the clinical classification (NYHA) or with the genesis of heart failure. Concerning a prophylactic anticoagulation, the results of the published studies and meta-analyses are inhomogenous with a benefit in some, no difference in others and a significant disadvantage for the patients with anticoagulation in a part of them compared to a non-treated control group. None of these data is established by a prospective, randomized, controlled study with the primary endpoint thromboembolic event in patients with or without anticoagulation. The incidence for a hemorrhage under anticoagulation is 0.6-5.3% per year for life-threatening and 0.04-0.64% for fatal bleeding.


CONCLUSIONS
Because of similar incidences for thromboembolic events and for the bleeding complication of anticoagulation, there is no evidence for a general indication for anticoagulation of patients with heart failure, persistent sinus rhythm and lack of risk factors. In patients with high-grade heart failure (e.g. VO2max < 14 ml/min/kg body weight or left ventricular ejection fraction < 20-30%), who belong to a high-risk population, anticoagulation should be considered and may be acceptable in individual cases.
Siaplaouras
S
S
Medizinische Universitäts- und Poliklinik, Innere Medizin III, Kardiologie/Angiologie, Universitätskliniken des Saarlandes, Homburg/Saar. siaplaouras@aol.com
Heisel
A
A
Buob
A
A
Jung
J
J
D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D011322:Primary Prevention; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000188:drug therapy*
D000925:Anticoagulants