Venous thromboembolic disease in congestive heart failure.
Congestive heart failure (CHF) is a medical condition associated with a relatively high risk of venous thromboembolism (VTE). Without thromboprophylaxis, venographically proven deep vein thrombosis occurs in 10% to 22% of hospitalized patients with CHF. Although the elevated VTE risk associated with CHF has been attributed to a variety of abnormalities in the context of Virchow's triad, newer information suggests that an associated chronic inflammatory state may be culpable. Both traditional VTE risk factors and cardiac-specific risk factors further increase the risk of VTE in patients with CHF. Severe left ventricular dysfunction, clinical instability (New York Heart Association class III-IV), young age, and/or right ventricular dysfunction appear to enhance the VTE risk associated with CHF. Grade IA pharmacologic thromboprophylactic recommendations for the hospitalized CHF patient include low molecular weight-heparin, fondaparinux, and low-dose unfractionated heparin. Regrettably, a variance in societal guidelines on the importance of VTE in hospitalized CHF patients may lead to underutilization of thromboprophylaxis.
Dean
Steven M
SM
Department of Cardiovascular Medicine, The Ohio State University College of Medicine, Columbus, USA. steven.dean@osumc.edu
Abraham
William
W
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D016001:Confidence Intervals; D017984:Enoxaparin / Q000627:therapeutic use; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications* / Q000503:physiopathology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D013318:Stroke Volume; D014481:United States; D054556:Venous Thromboembolism / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control; D016277:Ventricular Function, Left
D000925:Anticoagulants; D017984:Enoxaparin; D005343:Fibrinolytic Agents