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Hospitalization for heart failure may predict VTE risk
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Heart failure may serve as an independent risk factor for venous thromboembolism among hospitalized patients, according to the results of a systematic review and meta-analysis.
Patients at an increased risk for VTE should be treated with thromboprophylaxis, the researchers wrote.
Prior studies have assessed the association between heart failure and VTE; however, results have been inconsistent.
Yu Hu, MD, professor of hematology at Huazhong University of Science and Technology’s Tongji Medical College in Wuhan, China, and colleagues sought to quantify the absolute risk and RR for VTE among patients admitted to the hospital for heart failure. They further quantified rates of VTE among patients in different medical settings.
Hu and colleagues searched several medical databases for studies that examined VTE risk in hospitalized patients with heart failure. They identified 8,673 studies published between January 1955 and March 2015. They included 71 studies ― 68 full-length articles and three meeting abstracts ― in their final analysis.
Rates of VTE varied considerably in hospitalized patients with heart failure in different settings.
Overall, the median symptomatic VTE rate was 2.48% (interquartile range [IQR], 0.84-5.61), with rates of 3.73% (IQR, 1.05-7.31) among patients who did not receive thromboprophylaxis and 1.47% (IQR, 0.64-3.54) among those who did.
Hospitalized patients with heart failure had an overall RR of 1.51 (95% CI, 1.36-1.68; I2 = 96.1%). Egger’s test results did not indicate evidence of publication bias.
Study limitations included the inability to study the severity of heart failure due to lack of data, as well as the small number of studies (n = 6) that focused on acute heart failure. Further, the researchers were unable to account for many potential confounding factors.
“With an aging population, a greater proportion of VTE events are occurring in patients with heart failure who have been admitted to the hospital,” Hu and colleagues wrote. “In the absence of active bleeding or high bleeding risk, adequate and rigorous prophylaxis for VTE as done in clinical trials should be applied to patients with heart failure in clinical practice, although treating patients in a general setting can be very different from a clinical trial.”
Additional research is needed before regularly using thromboprophylaxis in the clinical setting, Torben Bjerregaard Larsen, MD, PhD, associate professor of cardiology and consultant for the Thrombosis Research Unit at Aalborg University in Denmark, wrote in an accompanying editorial.
“VTE is one aspect of the combined thromboembolic risk for patients with heart failure,” Larsen wrote. “Although some guidelines for chronic heart failure in adults state that anticoagulation should be considered for patients with heart failure in sinus rhythm, for those patients with a history of thromboembolism, left ventricular aneurysm or intracardiac thrombus, no general guidelines or clinical evidence support routine use of thromboprophylaxis. Further studies could reveal whether thromboprophylaxis should be recommended in high-risk patients with heart failure.” – by Cameron Kelsall
Disclosure: One study researcher reports consultant and speaking fees from Astellas, Bayer, Biotronik, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Medtronic, Microlife, Pfizer, Portola and Roche. The other researchers and Larsen report no relevant financial disclosures.
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