Document Detail

Dilated cardiomyopathy and role of antithrombotic therapy.
MedLine Citation:
PMID:  20186041     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: There is no consensus as to whether anticoagulation has a favorable risk:benefit in reducing thromboembolic events in patients with heart failure (HF) secondary to dilated cardiomyopathy who do not suffer from atrial fibrillation or primary valvular disease. METHODS AND RESULTS: The literature reviewed on this topic included most recent and ongoing studies that assessed the use of anticoagulation for this population. Several large retrospective studies showed an increased risk of thromboembolic events among patients with depressed left ventricular function. The relative risk of stroke in individuals with HF from all causes was found to be 4.1 for men and 2.8 for women, but confounding comorbidities (such as atrial fibrillation and coronary artery disease) were commonly present. Currently, there are no randomized prospective trials to guide the use of antithrombotics for these patients, and the risk of bleeding secondary to anticoagulation has limited the use of oral anticoagulants for prevention of thrombosis. Among patients with HF, increasing age directly correlates with both major bleeding and thromboembolic events, with a 46% relative risk of bleeding for each 10-year increase in age older than 40 years. CONCLUSIONS: To date, there is no agreement on appropriate antithrombotic treatment (if any) for primary thromboembolism prophylaxis in patients with dilated cardiomyopathy with sinus rhythm. In recent years, several promising prospective trials were terminated prematurely due to inadequate enrollment. The Warfarin Aspirin-Reduced Cardiac Ejection Fraction trial may provide evidence regarding the use of anticoagulation for patients with decreased myocardial function.
Ashraf S Abdo; Rhonda Kemp; Jennifer Barham; Stephen A Geraci
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  The American journal of the medical sciences     Volume:  339     ISSN:  1538-2990     ISO Abbreviation:  Am. J. Med. Sci.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-09     Completed Date:  2010-06-18     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370506     Medline TA:  Am J Med Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  557-60     Citation Subset:  AIM; IM    
Department of Medicine, University of Mississippi School of Medicine, Montgomery VA Medical Center, Jackson, 39216, USA.
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MeSH Terms
Anticoagulants / adverse effects,  therapeutic use*
Blood Coagulation / drug effects
Cardiomyopathy, Dilated / blood*,  complications
Fibrinolytic Agents / adverse effects,  therapeutic use*
Heart Failure / blood,  complications
Hemorrhage / chemically induced
Risk Assessment
Thromboembolism / etiology,  prevention & control*
Reg. No./Substance:
0/Anticoagulants; 0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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