Heart failure and cerebral ischemia

█ Review

DOI: 10.26430/CHUNGARICA.2021.51.2.103

Authors:
Tamer Sayın and Çetin Erol
Ankara University, School of Medicine, Department of Cardiology, Ankara, Turkey
Corresponding Author:
Çetin Erol, Professor, MD, e-mail: ctnerol@yahoo.com

Summary

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.

ISSUE: CARDIOLOGIA HUNGARICA | 2021 | VOLUME 51, ISSUE 2

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