title: Anticoagulation in patients with dilated cardiomyopathy, low ejection fraction, and sinus rhythm: back to the drawing board.
abstract: Heart failure patients present an important thrombo-embolic risk, including symptomatic or silent peripheral arterial embolism, pulmonary embolism, and stroke. Patients in sinus rhythm who have concomitant depressed (< 35%) left ventricular ejection fraction have a 4% rate of embolic events. Several prospective randomized trials of anticoagulation in this group of patients were either underpowered or had a short period of follow-up. Even though in two studies warfarin had a slight advantage over aspirin (in the WATCH and WARCEF trials), it was at the cost of an increased risk in major hemorrhage. To decrease bleeding rates and to improve anticoagulant effect, new treatment strategies have to be tested. Novel anticoagulants (dabigatran, rivaroxaban, and apixaban) seem to be a promising alternative.
authors.affiliation: Cardiology Department, "Bagdasar Arseni" Emergency Hospital, Bucharest, Romania.
authors.forename: Alexandru Nicolae
authors.initials: AN
authors.lastname: Mischie
authors.forename: Valentin
authors.initials: V
authors.lastname: Chioncel
authors.forename: Ionel
authors.initials: I
authors.lastname: Droc
authors.forename: Crina
authors.initials: C
authors.lastname: Sinescu
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D002986:Clinical Trials as Topic; D006339:Heart Rate; D006801:Humans; D020521:Stroke / Q000453:epidemiology; D013318:Stroke Volume
chemical_list: D000925:Anticoagulants
keywords: Apixaban; Dabigatran; Dilated cardiomyopathy; Heart failure; Low ejection fraction <35%; Rivaroxaban; Sinus rhythm