Heart failure and cerebral ischemia
Tamer Sayın and Çetin Erol
Ankara University, School of Medicine, Department of Cardiology, Ankara, Turkey
Çetin Erol, Professor, MD, e-mail: email@example.com
Heart failure patients may have impaired cerebral autoregulation and regional cerebral blood flow abnormalities. Predisposition to thromboembolic complications occur because of dilated chambers and abnormal blood flow, abnormal vessel/chamber lining and abnormal blood particles in heart failure patients. Epidemiological and clinical studies document an increased rate of thromboembolic complications in heart failure. Well known/accepted indications of oral anticoagulation therapy to prevent thromboembolic events are co-existence of atrial fibrillation/flutter, intracardiac thrombi and a history of a thromboembolic event. Other than a co-existence of coronary artery disease and heart failure, antiplatelet agents should not be used in heart failure patients to prevent ischemic stroke.
How and who to treat/prevent a thromboembolic event in patients with heart failure and sinus rhythm is a hot topic. Up to date, clinical studies of treatment with oral anticoagulant agents-mainly warfarin and recently rivaroxaban vs antiplatelet agents or placebo could not meet their primary outcome related with morbidity/mortality. In some of these studies, decreased rate of ischemic strokes were offset by increased major hemorrhage.