Anticoagulation in Congestive Cardiomyopathy: Steps Toward Defining the Great Unknown.

It is generally agreed that congestive cardiomyopathy predisposes to the formation of cardiac thrombus and in turn systemic thromboembolism. Several uncontrolled studies have confirmed this association and have prompted wide-scale recommendations for long-term anticoagulation in these patients. Clinical studies have also attempted to identify patients at high risk for embolic events. The presence of cardiac thrombus, its topographic characteristics, the severity of left ventricular dysfunction, and decreased apical flow velocities may each represent markers of increased risk.Driven by the lack of definitive data addressing this issue, several pleas from the medical community have come forth for a large, randomized controlled trial of anticoagulation in congestive cardiomyopathy. Accordingly, a multicenter trial comparing aspirin, warfarin, or placebo as prophylaxis against thromboembolism has been proposed and if conducted will provide valuable information regarding the management of patients with congestive cardiomyopathy.