Heart failure and venous thromboembolism: A major hidden risk

Improvement of outcomes for heart failure patients is an important goal. Sudden death in heart failure is common, but its causes are not well elucidated. Although the evidence base is limited, the combination of venous stasis, immobility and a hypercoagulable state suggest an increased venous thromboembolism risk, which in turn could lead to sudden death. Recent well conducted, randomised trials show that acutely ill hospitalised patients, including those with severe heart failure, are at moderate risk of venous thromboembolism, similar to the risk experienced by some surgical groups. They also show that the risk of venographically detected deep vein thrombosis can be reduced with antithrombotic prophylaxis. Recent consensus guidelines have introduced thromboprophylaxis recommendations that include heart failure as a major component. Several large clinical trials are ongoing that will help to define the effect of thromboprophylaxis on 'hard' clinical end points such as mortality.