At present , there are no data on the role of oral anticoagulation versus antiplatelet agents in heart failure with preserved ejection fraction with sinus rhythm .
Also , there were no data from RCTs on the utility of non-vitamin K antagonist oral anticoagulants compared to antiplatelet agents in heart failure with sinus rhythm
BACKGROUND Morbidity in patients with chronic heart failure is high , and this predisposes them to thrombotic complications , including stroke and thromboembolism , which in turn contribute to high mortality .
Oral anticoagulants ( e.g. warfarin ) and antiplatelet agents ( e.g. aspirin ) are the principle oral antithrombotic agents .
Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure .
Oral anticoagulants have become a st and ard in the management of heart failure with atrial fibrillation .
However , a question remains regarding the appropriateness of oral anticoagulants in heart failure with sinus rhythm .
This up date of a review previously published in 2012 aims to address this question .
OBJECTIVES To assess the effects of oral anticoagulant therapy versus antiplatelet agents for all-cause mortality , non-fatal cardiovascular events and risk of major bleeding in adults with heart failure ( either with reduced or preserved ejection fraction ) who are in sinus rhythm .
Ejection fraction and risk of thromboembolic events in patients with systolic dysfunction and sinus rhythm: evidence for gender differences in the studies of left ventricular dysfunction trials.
OBJECTIVES The aims of this study were to describe the incidence and spectrum of thromboembolic events experienced by patients with moderate to severe left ventricular systolic dysfunction in normal sinus rhythm and to study the association between ejection fraction and thromboembolic risk . BACKGROUND The annual incidence of thromboembolic events in patients with heart failure is estimated to range from 0.9 % to 5.5 % . Previous studies demonstrating a relation between worsening left ventricular systolic function and thromboembolic risk are difficult to interpret because of the prevalence of atrial fibrillation , an independent risk factor for thromboembolism , in the patients with a lower ejection fraction . METHODS This is a retrospective analysis of the Studies of Left Ventricular Dysfunction prevention and treatment trials data base . Patients with atrial fibrillation were excluded , result ing in 6,378 participants in sinus rhythm at the time of r and omization .  Thromboembolic events include strokes , pulmonary emboli and peripheral emboli . Separate analyses were conducted in each gender because there was evidence of a significant interaction between ejection fraction and gender on the risk of thromboembolic events ( p = 0.04 ) . RESULTS The overall annual incidence of thromboembolic events was 2.4 % in women and 1.8 % in men . On univariate analysis , a decline in ejection fraction was [ corrected ] associated with thromboembolic risk in women ( relative risk [ RR ] per 10 % decrease in ejection fraction 1.58 , 95 % confidence interval [ CI ] 1.10 to 2.26 , p = 0.01 ) , but not in men . On multivariate analysis , a decline in ejection fraction remained independently associated with thromboembolic risk in women ( RR per 10 % decrease 1.53 , 95 % CI 1.06 to 2.20 , p = 0.02 ) , but no relation was demonstrated in men . CONCLUSIONS In patients with left ventricular systolic dysfunction and sinus rhythm , the annual incidence of thromboembolic events is low . Ejection fraction appears to be independently associated with thromboembolic risk in women , but not in men
At present , there are no data on the role of oral anticoagulation versus antiplatelet agents in heart failure with preserved ejection fraction with sinus rhythm .
Also , there were no data from RCTs on the utility of non-vitamin K antagonist oral anticoagulants compared to antiplatelet agents in heart failure with sinus rhythm
BACKGROUND Morbidity in patients with chronic heart failure is high , and this predisposes them to thrombotic complications , including stroke and thromboembolism , which in turn contribute to high mortality .
Oral anticoagulants ( e.g. warfarin ) and antiplatelet agents ( e.g. aspirin ) are the principle oral antithrombotic agents .
Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure .
Oral anticoagulants have become a st and ard in the management of heart failure with atrial fibrillation .
However , a question remains regarding the appropriateness of oral anticoagulants in heart failure with sinus rhythm .
This up date of a review previously published in 2012 aims to address this question .
OBJECTIVES To assess the effects of oral anticoagulant therapy versus antiplatelet agents for all-cause mortality , non-fatal cardiovascular events and risk of major bleeding in adults with heart failure ( either with reduced or preserved ejection fraction ) who are in sinus rhythm .