[Anticoagulant therapy in patients with dilated cardiomyopathy]

Abstract

Heart failure due to dilated cardiomyopathy is associated with a significant increase in risk of thromboembolism. The incidence can be estimated, on the average, at 2.0-2.5 events per 100 patients per year. At this time, in the absence of randomized trials, limited evidence exists to support the use of anticoagulant treatment for patients with heart failure due to dilated cardiomyopathy in sinus rhythm, even if these subjects appear to be at higher risk than those with ischemic cardiomyopathy and comparable degree of left ventricular dysfunction. Women with left ventricular ejection fraction < 25% constitute a remarkable exception to this rule, and anticoagulation is strongly indicated for them. Unless there are contraindications, anticoagulant treatment is mandatory for patients with heart failure and atrial fibrillation. As studies on preventive treatment in atrial fibrillation have indicated, a target International Normalized Ratio between 2.0 and 3.0 seems appropriate. Patients with intraventricular thrombi present a difficult therapeutic challenge inasmuch as no strong evidence exists that anticoagulant treatment significantly decreases the risk of embolization particularly in patients with flat thrombus. Therapy should thus probably be limited to patients with pedunculated or floating thrombus.