Pharmacy Administration, University of New Mexico, 2211 Lomas Blvd NE, Albuquerque, NM 87106, USA.
Cardiol Rev. 2011 Jan-Feb;19(1):36-40. doi: 10.1097/CRD.0b013e318200166d.
Patients with systolic heart failure are thought to be at increased risk for thromboembolic events. Although these patients may have increased hypercoaguable markers, the incidence of stroke is thought to be relatively low. Still, oral anticoagulation with warfarin is sometimes prescribed in these patients to prevent potential thromboembolic events. Current guidelines do not recommend warfarin use in patients with systolic heart failure unless indicated for other cardiovascular conditions. Several studies that have attempted to address this controversy have, as a whole, demonstrated that the rates of thromboembolic events in patients with systolic heart failure taking warfarin are similar to those in patients taking placebo, basically showing no additional protective benefit of warfarin. In addition, these studies have shown an increased risk of bleeding with warfarin. However, these trials are of poor quality to date. The 4 post hoc analyses in this article had warfarin added at the investigators' discretion and included patients with indications for warfarin, such as atrial fibrillation. The 3 randomized trials in this article did not attain enrollment numbers to reach any calculated power and were stopped early; thus, they were unable to detect a difference. Since warfarin has shown benefit in patients with atrial fibrillation and in mechanical heart valves to decrease the risk of thromboembolism, it might stand to reason that warfarin would have the same benefit in systolic heart failure patients without the above indications. However, given the current available data, warfarin is not supported in patients with systolic heart failure in the absence of an indication for this drug.
患有收缩性心力衰竭的患者被认为有更高的血栓栓塞事件风险。尽管这些患者可能有更高的高凝标志物，但中风的发病率被认为相对较低。尽管如此，有时仍会为这些患者开具华法林等口服抗凝药物以预防潜在的血栓栓塞事件。目前的指南不建议在收缩性心力衰竭患者中使用华法林，除非有其他心血管疾病的指征。有几项试图解决这一争议的研究表明，服用华法林的收缩性心力衰竭患者的血栓栓塞事件发生率与服用安慰剂的患者相似，基本上没有显示华法林有额外的保护益处。此外，这些研究还表明华法林会增加出血风险。然而，迄今为止，这些试验的质量较差。本文中的 4 项事后分析可由研究者自行决定添加华法林，并纳入有华法林指征的患者，如心房颤动。本文中的 3 项随机试验没有达到计算出的入组人数，提前停止；因此，他们无法检测到差异。由于华法林已显示在心房颤动和机械心脏瓣膜患者中降低血栓栓塞风险的益处，因此可以认为华法林在没有上述指征的收缩性心力衰竭患者中也具有相同的益处。然而，鉴于目前可用的数据，在没有使用这种药物的指征的情况下，不支持在收缩性心力衰竭患者中使用华法林。
