What are the thromboembolic risks of heart failure combined with chronic or paroxysmal AF?
BACKGROUND
Heart failure (HF) and atrial fibrillation (AF) are common disorders that frequently occur together and are associated with an increased risk of thromboembolism. This thromboembolic risk may be reduced by anticoagulation with warfarin but not without introducing new hemorrhagic risks.


RESULTS
Current guidelines recommend the use of anticoagulation in patients with HF and chronic AF and paroxysmal AF (PAF) that is symptomatic or frequent and prolonged enough to be detected by electrocardiogram. However, the evidence supporting these recommendations is weak and does not take account of research indicating that the prothrombotic risk is higher in more severe HF.


CONCLUSIONS
An area not addressed by current guidelines is anticoagulation in patients with HF and short, asymptomatic episodes of AF. These issues need to be resolved with further studies using implanted devices to detect such asymptomatic PAF.
Caldwell
Jane Cochrane
JC
University of Manchester, Manchester Heart Centre, Manchester Royal Infirmary, Oxford Rd, Manchester, UK. jane.caldwell@manchester.ac.uk
Mamas
Mamas A
MA
Neyses
Ludwig
L
Garratt
Clifford J
CJ
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D002908:Chronic Disease; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D006801:Humans; D012307:Risk Factors; D013923:Thromboembolism / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
D000925:Anticoagulants