Antithrombotic therapy in congestive heart failure

The risk of thromboembolic complications is increased in patients with advanced chronic heart failure and severe left ventricular dysfunction. Accepted indications for oral anticoagulation include patients with a history of thromboembolism, concomitant atrial fibrillation, or venous, arterial or cardiac thrombosis. In other subgroups, the benefit of chronic anticoagulation has not been proven and existing data from uncontrolled nonrandomized, mostly retrospective studies and prospective, randomized controlled studies are conflicting. This article summarizes the available data on the thromboembolic risk and the potential benefit of antithrombotic therapy and attempts to provide current orientation and recommendations for anticoagulant therapy in patients with chronic heart failure and severe left ventricular dysfunction.