Author + information
- Received May 22, 2013
- Revision received July 25, 2013
- Accepted July 25, 2013
- Published online February 1, 2014.
- Paul A. Gurbel, MD∗ ( and )
- Udaya S. Tantry, PhD
- ↵∗Reprint requests and correspondence:
Dr. Paul A. Gurbel, Sinai Center for Thrombosis Research, Cardiac Catheterization Laboratory, 2401 West Belvedere Avenue, Baltimore, Maryland 21215.
There has been a 3-fold increase in hospital discharges for heart failure (HF) and also significantly increased mortality rate in HF patients in recent years. A major focus of HF research has been in the area of neurohormonal control and resynchronization therapy. There is a great urgency in better understanding the pathophysiology underlying the exceedingly high mortality and a need for exploration of therapeutic strategies beyond those that influence neurohormonal pathways. The decision to treat patients with HF with antiplatelet therapy remains largely influenced by the presence or absence of concomitant arterial disease. Antithrombotic therapy has been shown to be effective in many forms of cardiac disease, including patients with HF and atrial fibrillation. Although it is clear that platelet activation and hypercoagulability are present in HF, and there is evidence that stroke is reduced by warfarin therapy in the HF patient, the available data suggest that the risk of major bleeding overshadows the antithromboembolic benefit in HF patients in sinus rhythm. The utility of oral anticoagulant and/or antiplatelet therapy has never been evaluated in an adequately powered dedicated clinical trial of HF patients in sinus rhythm. In this state-of-the art paper we explore the evidence for targeting the inhibition of platelet function and coagulation to improve outcomes in the HF patient.
Dr. Gurbel has served as a consultant for Daiichi Sankyo, Sankyo, Lilly, Pozen, Novartis, Bayer, AstraZeneca, Accumetrics, Nanosphere, Sanofi-Aventis, Boehringer Ingelheim, Merck, Medtronic, Iverson Genetics, CSL, and Haemonetics; has received grants from the National Institutes of Health, Daiichi Sankyo, Lilly, Pozen, CSL, AstraZeneca, Sanofi-Aventis, Haemoscope, Medtronic, Harvard Clinical Research Institute, and Duke Clinical Research Institute; has received payment for lectures, including service on speakers’ bureaus from Lilly, Daiichi Sankyo, Nanosphere, Sanofi-Aventis, Merck, and Iverson Genetics; has received payment for development of educational presentations from Merck, the Discovery Channel, and Pri-Med; owns stock or stock options in Merck, Medtronic, and Pfizer; and holds patents in the area of personalized antiplatelet therapy and interventional cardiology. Dr. Tantry has reported that he has no relationships relevant to the contents of this paper.
- Received May 22, 2013.
- Revision received July 25, 2013.
- Accepted July 25, 2013.
- American College of Cardiology Foundation
- Pathophysiology of Arterial Thrombosis in HF
- Pathophysiology of Venous Thrombosis in HF
- Myocardial Infarction and Stroke Risk in HF
- Venous Thromboembolism
- Antithrombotic Therapy in Patients With HF
- Antiplatelet Therapy
- New Oral Anticoagulants
- Evidence for Antithrombotic Efficacy in HF
- Randomized Trials of Antithrombotic Therapy in HF
- Meta-Analyses of Randomized Trials and Registry Data
- Potential Role of New Anticoagulants
- Meta-Analysis of New Oral Anticoagulants