Thrombotic Complications in Heart Failure: An Under-Appreciated Challenge
Advances in pharmacological and devices therapy have greatly improved prognosis in patients with systolic heart failure. Despite this congestive heart failure still bears a very grim prognosis, particularly in patients with more advances stages of the disease that are so frequently seen on hospital wards.
Which pathogenic pathways may need to be addressed to improve prognosis in heart failure? The current treatment of this condition is primarily focused on performance of the heart itself, and aims to inhibit unfavorable cardiac remodeling (e.g., amelioration of impact of activated catecholamine and renin-angiotensin-aldosterone systems), optimization of cardiac hemodynamics (e.g., cardiac resynchronization therapy) and prevention of life threatening arrhythmia (e.g., insertion of implantable defibrillators). However, accumulating evidence suggests that thrombotic complications may play a major role in morbidity and outcomes in heart failure patients, especially as the cardiac 'targets' (largely neurohuneral) are being better managed.
- Received June 19, 2014.
- Revision received June 25, 2014.
- Accepted June 25, 2014.