Heart
failure (HF) with reduced left ventricular function inflicts a large and
growing burden of morbidity and mortality in the US and across the globe. One source of this burden is stroke. While it appears that HF itself may impose
some risk of stroke, it is in the presence of other risk factors, like atrial
fibrillation, that the greatest risks are observed. Therapeutic anticoagulation is the mainstay
of risk reduction strategies in this population. While warfarin was the only available therapy
for anticoagulation for many decades, there are now four direct oral anticoagulants
available. In three of these four,
outcomes in the specific subgroup of patients with heart failure have been
examined. In this review, we provide
some pathophysiologic basis for the risk of stroke in heart failure. In addition, the available therapeutic
options for stroke risk prevention in heart failure are described in detail
including how these options are incorporated into relevant professional society
guidelines.
Credits: Emily P. Zeitler; Zubin J Eapen