Use of novel oral anticoagulants in patients with heart failure.

OPINION STATEMENT: Pathophysiologically, there is a prothrombotic state evident in heart failure (HF). This is particularly evident within atria in patients whose course of the disease is complicated by concomitant atrial fibrillation (AF). A predisposition for thrombogenesis exists in patients with dilated dysfunctional cardiac chambers, such as those seen in patients with large myocardial infarction, left ventricular (LV) aneurysm or dilated cardiomyopathy. Based on subgroup analyses of recent phase 3 randomized trials, the novel oral anticoagulants are equally effective and safe in AF patients with HF or without HF. This appears to be true regarding both HF with systolic LV dysfunction and with preserved LVEF. However, patients with HF with preserved LVEF with more strict definition (ie, LVEF ≥ 55 %) have not been analyzed specifically. There is no information from clinical trial regarding possible utility of the novel oral anticoagulants in HF patients in sinus rhythm. Further research is required to cover gaps in knowledge on utility of these medications in a substantial proportion of HF patients not included in major clinical trials on novel oral anticoagulants.