Role of Antiplatelet Therapy and Anticoagulation in Nonischemic Cardiomyopathy.
Heart failure continues to be a leading cause of morbidity and mortality throughout the United States. The pathophysiology of heart failure involves the activation of complex neurohormonal pathways, many of which mediate not only hypertrophy and fibrosis within ventricular myocardium and interstitium, but also activation of platelets and alteration of vascular endothelium. Platelet activation and vascular endothelial dysfunction may contribute to the observed increased risk of thromboembolic events in patients with chronic heart failure. However, current data from clinical trials do not support the routine use of chronic antiplatelet or oral anticoagulation therapy for ambulatory heart failure patients without other indications (atrial fibrillation and/or coronary artery disease) as the risk of bleeding seems to outweigh the potential benefit related to reduction in thromboembolic events. In this review, we consider the potential clinical utility of targeting specific pathophysiological mechanisms of platelet and vascular endothelial activation to guide clinical decision making in heart failure patients.
From the *Department of Medicine, Division of Cardiology, Drexel University College of Medicine, Philadelphia, PA; and †Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York, NY.
Matthew
M
Carazo
Jeffrey S
JS
Berger
Alex
A
Reyentovich
Stuart D
SD
Katz
D002311:Cardiomyopathy, Dilated / Q000188:drug therapy*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D035501:Uncertainty
D010975:Platelet Aggregation Inhibitors