Department of Pharmacy Practice, College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 3660, Riyadh, 11481, Kingdom of Saudi Arabia.
King Abdulaziz Medical City, National Guard Health Affairs, Riyadh, Saudi Arabia.
Heart Fail Rev. 2024 Sep;29(5):1107-1116. doi: 10.1007/s10741-024-10422-w. Epub 2024 Jul 17.
Heart failure (HF) is considered one of a leading cause of cardiovascular morbidity and mortality worldwide. The association between HF and venous thromboembolism (VTE) has been reported in several studies owing to many physiological and thromboembolic risk factors. Thus, the need for extended thromboprophylaxis during the post-discharge period in HF patients has been evaluated. Most guidelines do not recommend extended thromboprophylaxis because of its uncertain benefits and increased risk of bleeding. However, recent evidence in HF patients revealed no increased risk of bleeding with extended thromboprophylaxis, which highlights the importance of identifying ideal candidates who might benefit from extended thromboprophylaxis. Several risk assessment models (RAMs) have been developed to identify patients at a high risk of VTE who would benefit from in-hospital and post-discharge prophylactic anticoagulation therapy based on the risk-benefit principle. However, their accuracy in predicting VTE is questionable, and none have a standardized approach for evaluating the risk of VTE in HF patients. In this review, we provided an overview of the incidence and pathophysiology of VTE in HF patients, a summary of guideline recommendations for VTE prevention, and a summary of studies evaluating the use of extended thromboprophylaxis, with a focus on subgroup or post-hoc analyses of HF patients. We also discussed the need to design an ideal RAM that can identify candidate patients for extended thromboprophylaxis by stratifying the risk of VTE and identifying the key risk factors for bleeding in medically ill patients, including those with HF.
心力衰竭（HF）被认为是全球心血管发病率和死亡率的主要原因之一。由于存在许多生理和血栓栓塞风险因素，已有多项研究报道 HF 与静脉血栓栓塞症（VTE）之间存在关联。因此，需要评估 HF 患者出院后延长血栓预防的必要性。由于其不确定的益处和出血风险增加，大多数指南不建议延长血栓预防。然而，HF 患者的最新证据表明，延长血栓预防不会增加出血风险，这凸显了确定可能受益于延长血栓预防的理想患者的重要性。已经开发了几种风险评估模型（RAM），以根据风险效益原则，识别有发生 VTE 高风险的患者，这些患者将从住院和出院后预防性抗凝治疗中受益。然而，它们预测 VTE 的准确性存在疑问，并且没有一种标准化的方法来评估 HF 患者 VTE 的风险。在这篇综述中，我们概述了 HF 患者 VTE 的发生率和病理生理学，总结了 VTE 预防指南的建议，以及评估延长血栓预防应用的研究，重点是 HF 患者的亚组或事后分析。我们还讨论了设计理想的 RAM 的必要性，该 RAM 可以通过分层 VTE 的风险和识别包括 HF 患者在内的患有内科疾病患者的出血关键风险因素，来确定延长血栓预防的候选患者。
