Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan.
Department of Cardiology, Tokyo Medical University, Tokyo, Japan.
Sci Rep. 2021 Jan 13;11(1):1202. doi: 10.1038/s41598-020-79700-5.
Although the risk of thromboembolism is increased in heart failure (HF) patients irrespective of atrial fibrillation (AF), especially during the acute decompensated phase, the effects of intravenous anticoagulants for these patients remain unclear. We sought to investigate the current practice and effects of intravenous anticoagulant therapy in acute HF (AHF) patients with sinus rhythm. We analyzed a nationwide prospective cohort from April 2012 to March 2016. We extracted 309,015 AHF adult patients. After application of the exclusion criteria, we divided the 92,573 study population into non-heparin [n = 70,621 (76.3%)] and heparin [n = 21,952 (23.7%)] groups according to the use of intravenous heparin for the first 2 consecutive days after admission. Multivariable logistic regression analyses demonstrated that heparin administration was not associated with in-hospital mortality (OR 0.97, 95% CI 0.91-1.03) and intracranial hemorrhage (OR 1.18, 95% CI 0.78-1.77), while heparin administration was significantly associated with increased incidence of ischemic stroke (OR 1.49, 95% CI 1.29-1.72) and venous thromboembolism (OR 1.62, 95% CI 1.14-2.30). In conclusion, intravenous heparin administration was not associated with favorable in-hospital outcomes in AHF patients with sinus rhythm. Routine additive use of intravenous heparin to initial treatment might not be recommended in AHF patients.
尽管心力衰竭（HF）患者无论是否存在心房颤动（AF），尤其是在急性失代偿期，血栓栓塞的风险都会增加，但这些患者的静脉内抗凝治疗效果仍不清楚。我们旨在研究窦性心律的急性 HF（AHF）患者中，目前静脉内抗凝治疗的应用情况和效果。我们分析了 2012 年 4 月至 2016 年 3 月的一项全国性前瞻性队列研究。共纳入了 309015 例 AHF 成年患者。在应用排除标准后，我们根据入院后前 2 天连续使用静脉肝素的情况，将 92573 例研究人群分为非肝素组（n = 70621，76.3%）和肝素组（n = 21952，23.7%）。多变量逻辑回归分析表明，肝素的应用与院内死亡率（OR 0.97，95%CI 0.91-1.03）和颅内出血（OR 1.18，95%CI 0.78-1.77）无关，而肝素的应用与缺血性卒中（OR 1.49，95%CI 1.29-1.72）和静脉血栓栓塞（OR 1.62，95%CI 1.14-2.30）发生率增加相关。总之，在窦性心律的 AHF 患者中，静脉内肝素的应用与院内良好预后无关。在 AHF 患者中，初始治疗时常规添加静脉肝素可能不推荐使用。
