Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm An Executive Summary# of a joint Consensus Document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis
Thromboembolism and antithrombotic therapy for heart failure in sinus rhythm An Executive Summary# of a joint Consensus Document from the ESC Heart Failure Association and the ESC Working Group on Thrombosis
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DOI：
10.1160/th12-08-0578
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发表时间：
2012-12-01
影响因子：
6.7
通讯作者：
Lane, Deirdre A.
中科院分区：
文献类型：
--
作者：
Lip, Gregory Y. H.;Ponikowski, Piotr;Lane, Deirdre A.
慢性心力衰竭（HF）伴左心室（LV）射血分数降低或保留是常见的，并且仍然是一种非常严重的疾病，具有高死亡率和发病率。与心力衰竭相关的许多并发症可能与血栓形成有关。流行病学和病理生理学数据也将HF与血栓形成风险增加联系起来，导致猝死、卒中、全身血栓栓塞和/或静脉血栓栓塞的临床后果。欧洲心脏病学会（ESC）心力衰竭协会（EHFA）和ESC血栓形成工作组的联合共识文件的执行摘要审查了已发表的证据，总结了“最佳实践”，并提出了共识声明，可能有助于定义证据差距并协助日常临床实践中的管理决策。明确建议房颤HF患者口服抗凝剂，应使用CHA（2）DS（2）-VASc和HAS流血的评分确定口服抗凝剂的可能风险获益比（血栓栓塞预防与出血风险）。在窦性心律的LV射血分数降低的HF患者中，没有证据表明维生素K拮抗剂（例如华法林）对死亡率有总体获益，但有大出血风险。虽然有可能减少缺血性卒中，但目前还没有令人信服的理由对这些患者常规使用华法林。应确定与血栓栓塞事件风险增加相关的风险因素，并在平衡血栓栓塞风险与出血风险时，个体化患者的价值观和偏好是重要的决定因素。与华法林相比，提供不同风险-获益特征的新型口服抗凝剂可能是一种有吸引力的治疗选择，但这需要在临床试验中得到证实。
Chronic heart failure (HF) with either reduced or preserved left ventricular (LV) ejection fraction is common and remains an extremely serious disorder with a high mortality and morbidity. Many complications related to heart failure can be related to thrombosis Epidemiological and pathophysiological data also link HF,to an increased risk of thrombosis, leading to the clinical consequences of sudden death, stroke, systemic thromboembolism and/or venous thromboembolism. This executive summary of a joint consensus document of the Heart Failure Association (EHFA) of the European Society of Cardiology (ESC) and the ESC Working Group on Thrombosis reviews the published evidence, summarises 'best practice', and puts forward consensus statements that may help to define evidence gaps and assist management decisions in everyday clinical practice. In HF patients with atrial fibrillation oral anticoagulation is clearly recommended, and the CHA(2)DS(2)-VASc and, HAS BLED scores should be used to determine the likely risk benefit ratio (thromboembolism prevention versus risk of bleeding) of oral anticoagulation. In HF patients with reduced LV ejection fraction who are in Sinus rhythm there is no evidence of an overall benefit of vitamin K antagonists (e.g. warfarin) on mortality, with risk of major bleeding. Whilst there is the potential fora reduction in ischaemic stroke, there is currently no compelling reason to routinely Use Warfarin for these patients. Risk factors associated with increased risk of thromboembolic events should be identified and decisions regarding use of anticoagulation individualised Patient values and preferences are important determinants when balancing the risk of thromboembolism against :bleeding risk Novel oral anticoagulants that offer a different risk-benefit profile compared with warfarin may appear as an attractive therapeutic option, but this would need to be confirmed in clinical trials.