Thromboembolism in heart failure: who should be treated?

The risk of thromboembolic complications in patients with heart failure and /or chronic left-ventricular systolic dysfunction is increased. Nevertheles s, anticoagulant therapy in these patients is still a subject of debate. At rial fibrillation is the only prospectively evaluated, proven thromboemboli c risk factor and patients with atrial fibrillation benefit from long term anticoagulant therapy. The significance of other proposed thromboembolic ri sk factors in heart failure and/or chronic left-ventricular dysfunction suc h as gender, cause of myocardial disease, severity of heart failure, left-v entricular ejection fraction, left-ventricular thrombus, left ventricular a neurysm and history of previous thromboembolic event is less clear. This ar ticle summarizes key studies, assesses the incidence of thromboembolism, ev aluates risk factors and proposes guidelines for anticoagulation of patient s with heart failure and/or left ventricular systolic dysfunction. (C) 2000 European Society of Cardiology. All rights reserved.