Aspirin, oral anticoagulants and cardiac failure

The incidence of thromboembolic complications in patients with cardiac fail ure is low. The predisposing factors are principally the presence of a left ventricular mural thrombus, atrial fibrillation, a low ejection fraction a nd a low peak VO2. The risk of cerebral haemorrhage in a patient with cardiac failure treated with oral anticoagulants is about the same as the risk of thromboembolism. Therefore, anticoagulant therapy for patients with cardiac failure is contr oversial in the absence of a prospective large scale clinical trial demonst rating its benefits. In the meantime, a prudent approach with risk stratification to determine w hich patients would benefit the most from oral anticoagulation is advised.