Antithrombotic agents

John G.F. Cleland, Azam Torabi, Jufen Zhang and Raj K. Chelliah

in Oxford Textbook of Heart Failure

Published on behalf of Oxford University Press

ISBN: 9780199577729
Published online July 2011 | e-ISBN: 9780199697809 | DOI:

Series: Oxford Textbooks

Antithrombotic agents

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Heart failure (HF) and the causes of HF provide, theoretically, a powerful pathophysiological substrate for thrombosis but there is remarkably little evidence that the rate of thrombotic events can be reduced by antithrombotic therapy. HF is often associated with coronary artery disease and with atrial fibrillation two conditions for which long-term antithrombotic agents are traditionally given. Accordingly, many consider it unnecessary to investigate whether antithrombotic agents are effective in HF, since they consider the result a foregone conclusion. Some would even consider it unethical to withhold antithrombotic agents in patients with HF. Such an opinion reflects a general lack of rigour in the analysis and interpretation of long-term trials of antithrombotic agents for cardiovascular disease, undermining the scientific basis of medicine. It is widely perceived that patients with HF have high rates of vascular occlusive events, including myocardial infarction (MI) and stroke, but this may not be true. Reported rates of MI and stroke are certainly low compared to mortality in patients with HF. Moreover, treatment directed at reducing the risk of vascular events, including aspirin, statins, and coronary revascularization, has not yet been shown to reduce mortality in patients with HF, even though statins reduce the rate of nonfatal vascular events.

In summary, the contribution of vascular occlusive events to the morbidity and mortality of HF is uncertain. Too many opinions have been based on too few facts, resulting in recommendations about management that are only weakly supported by evidence. A lot of this stems from misinterpretation of the effects of aspirin in long-term trials of patients with atherosclerotic vascular disease.

Chapter.  7401 words.  Illustrated.

Subjects: Cardiovascular Medicine

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