warfarin and Cardiomyopathy--Dilated

People with chronic heart failure (HF) are at risk of thromboembolic events, including stroke, pulmonary embolism, and peripheral arterial embolism; coronary ischaemic events also contribute to the progression of HF. The use of long-term oral anticoagulation is established in certain populations, including people with HF and atrial fibrillation (AF), but there is wide variation in the indications and use of oral anticoagulation in the broader HF population.. To determine whether long-term oral anticoagulation reduces total deaths and stroke in people with heart failure in sinus rhythm.. We updated the searches in CENTRAL, MEDLINE, and Embase in March 2020. We screened reference lists of papers and abstracts from national and international cardiovascular meetings to identify unpublished studies. We contacted relevant authors to obtain further data. We did not apply any language restrictions.. Randomised controlled trials (RCT) comparing oral anticoagulants with placebo or no treatment in adults with HF, with treatment duration of at least one month. We made inclusion decisions in duplicate, and resolved any disagreements between review authors by discussion, or a third party.. Two review authors independently assessed trials for inclusion, and assessed the risks and benefits of antithrombotic therapy by calculating odds ratio (OR), accompanied by the 95% confidence intervals (CI).. We identified three RCTs (5498 participants). One RCT compared warfarin, aspirin, and no antithrombotic therapy, the second compared warfarin with placebo in participants with idiopathic dilated cardiomyopathy, and the third compared rivaroxaban with placebo in participants with HF and coronary artery disease. We pooled data from the studies that compared warfarin with a placebo or no treatment. We are uncertain if there is an effect on all-cause death (OR 0.66, 95% CI 0.36 to 1.18; 2 studies, 324 participants; low-certainty evidence); warfarin may increase the risk of major bleeding events (OR 5.98, 95% CI 1.71 to 20.93, NNTH 17). 2 studies, 324 participants; low-certainty evidence). None of the studies reported stroke as an individual outcome. Rivaroxaban makes little to no difference to all-cause death compared with placebo (OR 0.99, 95% CI 0.87 to 1.13; 1 study, 5022 participants; high-certainty evidence). Rivaroxaban probably reduces the risk of stroke compared to placebo (OR 0.67, 95% CI 0.47 to 0.95; NNTB 101; 1 study, 5022 participants; moderate-certainty evidence), and probably increases the risk of major bleeding events (OR 1.65, 95% CI 1.17 to 2.33; NNTH 79; 1 study, 5008 participants; moderate-certainty evidence).. Based on the three RCTs, there is no evidence that oral anticoagulant therapy modifies mortality in people with HF in sinus rhythm. The evidence is uncertain if warfarin has any effect on all-cause death compared to placebo or no treatment, but it may increase the risk of major bleeding events. There is no evidence of a difference in the effect of rivaroxaban on all-cause death compared to placebo. It probably reduces the risk of stroke, but probably increases the risk of major bleedings. The available evidence does not support the routine use of anticoagulation in people with HF who remain in sinus rhythm.

Topics: Administration, Oral; Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Chronic Disease; Heart Failure; Heart Rate; Hemorrhage; Humans; Placebo Effect; Placebos; Randomized Controlled Trials as Topic; Rivaroxaban; Stroke; Thromboembolism; Warfarin

Patients with chronic heart failure (heart failure) are at risk of thromboembolic events, including stroke, pulmonary embolism and peripheral arterial embolism, whilst coronary ischaemic events also contribute to the progression of heart failure. Long-term oral anticoagulation is established in certain patient groups, including patients with heart failure and atrial fibrillation, but there is wide variation in the indications and use of oral anticoagulation in the broader heart failure population.. To determine whether long-term oral anticoagulation reduces total deaths, cardiovascular deaths and major thromboembolic events in patients with heart failure.. We updated the searches in June 2030 in the electronic databases CENTRAL (Issue 6, 2013) in The Cochrane Library, MEDLINE (OVID, 1946 to June week 1 2013) and EMBASE (OVID, 1980 to 2013 week 23). Reference lists of papers and abstracts from national and international cardiovascular meetings were studied to identify unpublished studies. Relevant authors were contacted to obtain further data. No language restrictions were applied.. Randomised controlled trials (RCTs) comparing oral anticoagulants with placebo in adults with heart failure, and with treatment duration at least one month. Non-randomised studies were also included for assessing side effects. Inclusion decisions were made in duplicate and any disagreement between review authors was resolved by discussion or a third party.. Two review authors independently assessed trials for inclusion and assessed the risks and benefits of antithrombotic therapy using relative measures of effects, such as odds ratio, accompanied by the 95% confidence intervals.. Two RCTs were identified. One compared warfarin, aspirin and no antithrombotic therapy and the second compared warfarin with placebo in patients with idiopathic dilated cardiomyopathy. Three small prospective controlled studies of warfarin in heart failure were also identified, but they were over 50 years old with methods not considered reliable by modern standards. In both WASH 2004 and HELAS 2006, there were no significant differences in the incidence of myocardial infarction, non-fatal stroke and death between patients taking oral anticoagulation and those taking placebo. Four retrospective non-randomised cohort analyses and four observational studies of oral anticoagulation in heart failure included differing populations of heart failure patients and reported contradictory results.. Based on the two major randomised trials (HELAS 2006; WASH 2004), there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm. Although oral anticoagulation is indicated in certain groups of patients with heart failure (for example those with atrial fibrillation), the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm.

Topics: Administration, Oral; Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Chronic Disease; Heart Failure; Heart Rate; Humans; Placebo Effect; Randomized Controlled Trials as Topic; Thromboembolism; Warfarin

The management of cardiomyopathy in pediatric patients is complicated by the risk of cardiac-associated embolism. This review examines the incidence, risk factors, and treatment of embolism in dilated cardiomyopathy (DCM), restrictive cardiomyopathy (RCM), and noncompaction of the left ventricular myocardium (NLVM) in children. The reported incidence of embolism for DCM ranges from 1 to 16%. Left ventricular ejection fraction below 25% or fractional shortening below 15% are major risk factors for intracardiac thrombus formation in this group. The risk of embolism for RCM ranges from 12 to 33%. Atrial dilation is considered the major risk factor. The reported incidence of embolism for NLVM ranges from 0 to 38%, with most studies indicating an absence of detectable thrombus or embolus. Severe systolic dysfunction exacerbates the risk of embolism in this group. On the basis of these risk factors, we propose an algorithm for the management of embolism in these groups of patients.

Topics: Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Cardiomyopathy, Restrictive; Child; Disease Management; Embolism; Humans; Risk Factors; Thrombosis; Ventricular Dysfunction, Left; Ventricular Function, Left; Warfarin

The risk of thromboembolism in chronic heart failure and the risk-to-benefit ratio of anticoagulation in this population are poorly defined.. A PubMed/MEDLINE search of published trials was performed. Twenty-four studies were identified after exclusion of individual case reports. All studies were prospective or retrospective observational reports, either independent studies or secondary analyses of prospective clinical trials in patients with heart failure. Prevalence estimates ranged of thromboemboli ranged from 3% to 50% and incidence estimates ranged from 1.5 to 3.5/100 patient-years. Although no randomized data of therapeutic anticoagulation were identified, a secondary analysis of one study suggested event reduction in patients receiving warfarin anticoagulation; other studies failed to suggest such benefit. Overall bleeding estimates in warfarin-treated patients ranged from 2.3 to 6.8/100 patient-years. Intracranial hemorrhage rates were 0.62 to 0.9/100 patient-years but increased with age. Only one study suggested that aspirin was beneficial in reducing clinically significant emboli.. Although patients with chronic heart failure and left ventricular dilation have a higher risk of thromboembolism, data are insufficient to recommend warfarin or aspirin prophylaxis in the absence of additional indications for such therapy.

Topics: Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Heart Failure; Humans; Incidence; Thromboembolism; Warfarin

Topics: Adrenergic beta-Antagonists; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Digitalis; Diuretics; Hemodynamics; Humans; Male; Middle Aged; Plants, Medicinal; Plants, Toxic; Warfarin

It is not clear if long-term antithrombotic treatment has a beneficial effect on the incidence of thromboembolism in chronic heart failure (CHF). The HELAS study (Heart failure Long-term Antithrombotic Study) is a multicentre, randomised, double-blind, placebo-controlled trial to evaluate antithrombotic treatment in patients with CHF.. 197HF patients (EF <35%) were enrolled. Patients with Ischaemic Heart Disease were randomised to receive either aspirin 325mg or warfarin. Patients with Dilated Cardiomyopathy (DCM) were randomised to receive either warfarin or placebo.. Analysis of the data from 312 patient years showed an incidence of 2.2 embolic events per 100 patient years, with no significant difference between groups. The incidence of myocardial infarction, hospitalisation, exacerbation of heart failure, death and haemorrhage were not different between the groups. No peripheral or pulmonary emboli were reported. Echocardiographic follow-up for 2years showed an overall increase in left ventricular ejection fraction from 28.2+/-6 to 30.3+/-7 p<0.05, which was most obvious in patients with DCM taking warfarin (EF 26.8+/-5.3 at baseline, 30.7+/-10 at 2 years, p<0.05).. (1) Overall embolic events are rare in heart failure regardless of treatment. (2) Treatment does not seem to affect outcome.

Topics: Aged; Anticoagulants; Antithrombins; Aspirin; Cardiac Output, Low; Cardiomyopathy, Dilated; Double-Blind Method; Female; Humans; Male; Middle Aged; Myocardial Ischemia; Placebos; Thromboembolism; Warfarin

Heart failure is commonly associated with vascular disease and a high rate of athero-thrombotic events, but the risks and benefits of antithrombotic therapy are unknown.. The current study was an open-label, randomized, controlled trial comparing no antithrombotic therapy, aspirin (300 mg/day), and warfarin (target international normalized ratio 2.5) in patients with heart failure and left ventricular systolic dysfunction requiring diuretic therapy. The primary objective was to demonstrate the feasibility and inform the design of a larger outcome study. The primary clinical outcome was death, nonfatal myocardial infarction, or nonfatal stroke.. Two hundred seventy-nine patients were randomized and 627 patient-years exposure were accumulated over a mean follow-up time of 27 +/- 1 months. Twenty-six (26%), 29 (32%), and 23 (26%) patients randomized to no antithrombotic treatment, aspirin, and warfarin, respectively, reached the primary outcome (ns). There were trends to a worse outcome among those randomized to aspirin for a number of secondary outcomes. Significantly (P =.044) more patients randomized to aspirin were hospitalized for cardiovascular reasons, especially worsening heart failure.. The Warfarin/Aspirin Study in Heart failure (WASH) provides no evidence that aspirin is effective or safe in patients with heart failure. The benefits of warfarin for patients with heart failure in sinus rhythm have not been established. Antithrombotic therapy in patients with heart failure is not evidence based but commonly contributes to polypharmacy.

Topics: Aged; Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Feasibility Studies; Female; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Platelet Aggregation Inhibitors; Stroke; Warfarin

Topics: Cardiomyopathy, Dilated; Cerebrovascular Disorders; Echocardiography, Doppler; Humans; Randomized Controlled Trials as Topic; Warfarin

The prognosis of patients with idiopathic dilated cardiomyopathy (DCM) has improved remarkably in recent decades with guideline-directed medical therapy. Left ventricular (LV) reverse remodeling (LVRR) is one of the major therapeutic goals. Whether myocardial fibrosis or inflammation would reverse associated with LVRR remains unknown.. A total of 157 prospectively enrolled patients with DCM underwent baseline and follow-up cardiovascular magnetic resonance examinations with a median interval of 13.7 months (interquartile range, 12.2-18.5 months). LVRR was defined as an absolute increase in LV ejection fraction of >10% to the final value of ≥35% and a relative decrease in LV end-diastolic volume of >10%. Statistical analyses were performed using paired. Forty-eight (31%) patients reached LVRR. At baseline, younger age, worse New York Heart Association class, new-onset heart failure, lower LV ejection fraction, absence of late gadolinium enhancement, lower myocardial T2, and extracellular volume were significant predictors of LVRR. During the follow-up, patients with and without LVRR both showed a significant decrease of myocardial native T1 (LVRR: [baseline] 1303.0±43.6 ms; [follow-up] 1244.7±51.8 ms; without LVRR: [baseline] 1308.5±80.5 ms; [follow-up] 1287.6±74.9 ms, both. In patients with idiopathic DCM, the absence of late gadolinium enhancement, lower T2, and extracellular volume values at baseline are significant predictors of LVRR. The myocardial T1, matrix, and cell volume decrease significantly in patients with LVRR after guideline-directed medical therapy. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: ChiCTR1800017058.

Topics: Adrenergic beta-Antagonists; Adult; Age Factors; Angiotensin Receptor Antagonists; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiomyopathy, Dilated; Cardiotonic Agents; Cardiovascular Agents; Digoxin; Diuretics; Extracellular Space; Female; Humans; Magnetic Resonance Imaging; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Mineralocorticoid Receptor Antagonists; Practice Guidelines as Topic; Prognosis; Severity of Illness Index; Stroke Volume; Ventricular Remodeling; Warfarin

Atrial fibrillation and heart failure are factors predisposing to locally formed intracardiac thrombosis, which is usually localized in left-sided chambers. A case report. The authors present a case of a 50-year-old male with permanent atrial fibrillation and dilated cardiomyopathy in whom recurrent right atrial thrombus was observed. Initially, the lesion was detected in echocardiography while he was hospitalized due to extensive right-sided pneumonia. The thrombus was successfully treated with heparin, followed by warfarin. Even though the patient continued warfarin use properly, there was recurrence of the thrombus two years later during a new episode of heart failure exacerbation. Because the thrombus was resistant to intensified anticoagulation, cardiac surgery was needed. A large (30 x 25 mm) pedunculated thrombus, as well as two smaller ones (each of 10 x 10 mm) attached closely to the atrial wall and previously not detected either by echocardiography or by magnetic resonance imaging, were excited. A partially organized pattern of the thrombi in histological examination can explain lack of anticoagulation effectiveness.

Topics: Anticoagulants; Atrial Fibrillation; Cardiomyopathy, Dilated; Echocardiography; Heart Atria; Heart Diseases; Heart Failure; Heparin; Humans; Male; Middle Aged; Recurrence; Thrombosis; Warfarin

Left ventricular assist devices (LVADs) have been increasingly used for 20 years in terminally ill patients with advanced heart failure or awaiting cardiac transplantation. Despite improvement in morbidity and mortality from use of these devices, quality of life may be limited by cataract. Access to cataract surgery in this predominantly elderly population is essential but limited by unfamiliarity with these devices. We describe phacoemulsification and intraocular lens implantation in 2 patients with LVADs. The patients had extensive preoperative cardiology evaluations and were instructed to continue warfarin through the day of surgery. Monitored sedation was used with fentanyl and midazolam. Both patients experienced significant improvement in visual acuity and quality of life. Neither experienced intraoperative hemodynamic instability. Cataract surgery may be safely performed in patients with LVAD support when adequate monitoring resources are available.. No author has a financial or proprietary interest in any material or method mentioned.

Topics: Activities of Daily Living; Aged; Anticoagulants; Cardiomyopathy, Dilated; Cataract; Heart Failure; Heart-Assist Devices; Humans; Lens Implantation, Intraocular; Male; Middle Aged; Phacoemulsification; Quality of Life; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Blood Vessel Prosthesis; Cardiomyopathy, Dilated; Humans; Palliative Care; Practice Guidelines as Topic; Stroke; Warfarin

Topics: Aged; Anticoagulants; Aortic Valve; Cardiomyopathy, Dilated; Female; Heart-Assist Devices; Humans; Thrombosis; Warfarin

Topics: Acute Kidney Injury; Adult; Anti-Bacterial Agents; Anticoagulants; Blood Coagulation Disorders; Cardiomyopathy, Dilated; Drug Interactions; Hematuria; Humans; International Normalized Ratio; Levofloxacin; Male; Ofloxacin; Shock; Urinary Tract Infections; Warfarin

Topics: Aged; Anticoagulants; Cardiomyopathy, Dilated; Coronary Thrombosis; Echocardiography; Electrocardiography; Female; Heart Ventricles; Humans; Warfarin

Topics: Adult; Anticoagulants; Aortic Valve; Cardiomyopathy, Dilated; Fibrinolysis; Fluoroscopy; Heart Valve Prosthesis; Humans; Male; Remission, Spontaneous; Thrombosis; Ventricular Outflow Obstruction; Warfarin

Significant systolic improvement and reverse remodeling in dilated cardiomyopathy (DCM) are well known, however they have been rarely described among elderly subjects. The authors retrospectively reviewed 86 patients with a diagnosis of DCM seen at a clinic during April-November 2005. The authors found 18 patients with elderly-onset idiopathic DCM (age of onset > or = 65 years, mean age 71.8 +/- 6.2 years), who had substantial improvement in left ventricular ejection fraction (LVEF) > or = 20 units (%). During a mean follow-up of 8.6 +/- 5.5 years, mean LVEF and left ventricular end-diastolic diameter improved from 30.6 +/- 7.9% to 58.3 +/- 6.5% (p < 0.0001) and 57.5 +/- 7.0 mm to 44.6 +/- 5.5 mm (p < 0.0001), respectively Fifteen of the 18 patients (83%) had a history of hypertension. Systolic blood pressure at the initial referral clinic correlated with improved contractility (p = 0.0275, r = 0.52). The eighteen patients found in our small patient population suggest that substantial systolic improvement and reverse remodeling is seen in elderly patients with idiopathic DCM.

Topics: Adrenergic beta-Antagonists; Aged; Angiotensin II Type 1 Receptor Blockers; Angiotensin-Converting Enzyme Inhibitors; Anticoagulants; Cardiomyopathy, Dilated; Cardiotonic Agents; Digoxin; Female; Humans; Male; Retrospective Studies; Stroke Volume; Systole; Ultrasonography; Ventricular Function, Left; Ventricular Remodeling; Warfarin

Myocarditis and dilated cardiomyopathy is characterized by dilatation of all four cardiac chambers and decreased systolic function of the heart, especially in the left ventricle. In this report we presented a patient with myocarditis or dilated cardiomyopathy and deficiency of protein C and protein S with biventricular multiple intracardiac thrombi. Standard heparin infusion and acetyl salicylic acid was begun. On the 10th day of hospitalization the right ventricular thrombus disappeared, and on the 24th day all thrombi in the left ventricle disappeared. During the treatment we did not observe any complication such as hemorrhagia or embolism. We think that patients with dilated cardiomyopathy or myocarditis should be evaluated for hemostatic disorders, and should be anticoagulated if any of these disorders are presented.

Topics: Anticoagulants; Aspirin; Cardiomyopathy, Dilated; Child, Preschool; Female; Fibrinolytic Agents; Heart Diseases; Heart Ventricles; Heparin; Humans; Protein C Deficiency; Protein S Deficiency; Thrombosis; Treatment Outcome; Ultrasonography; Warfarin

A 53-year-old man presented to hospital 2 hours after the abrupt onset of left upper abdominal pain. He was treated with analgesics and discharged after 4 hours of observation, but presented to another hospital 2 hours later with severe left abdominal pain. His past medical history included ischemic dilated cardiomyopathy due to recurrent myocardial infarction.. Physical examination, electrocardiography, laboratory investigations, contrast-enhanced computed tomography, and transesophageal echocardiography.. Renal artery thromboembolism resulting from dilated cardiomyopathy, severely reduced cardiac function and an intracardiac thrombus.. Anticoagulation with unfractionated heparin followed by enoxaparin and warfarin.

Topics: Abdominal Pain; Acute Disease; Anticoagulants; Cardiomyopathy, Dilated; Coronary Thrombosis; Diagnosis, Differential; Echocardiography, Transesophageal; Enoxaparin; Humans; Infarction; Kidney Diseases; Male; Middle Aged; Renal Artery; Tomography, X-Ray Computed; Warfarin

Our institution has used the DeBakey VAD Child as a bridge to heart transplantation in select pediatric patients. Pump thrombus is a potentially serious complication with few available treatment options. Only surgical device exchange or the use of tissue plasminogen activator are reported in the literature. We report the use of clopidogrel as an alternative thrombolytic agent in the presence of pump thrombus in an adolescent patient with a DeBakey VAD Child heart pump.

Topics: Adolescent; Aspirin; Cardiomyopathy, Dilated; Clopidogrel; Equipment Failure; Fibrinolytic Agents; Heart Transplantation; Heart-Assist Devices; Humans; Male; Thrombosis; Ticlopidine; Warfarin

Dilated cardiomyopathy and the resultant left ventricular dysfunction are risk factors for thrombus formation in the heart, reflecting the intimate relationship between structure and function in this vital organ. Once formed, depending on size, location, and mobility, left ventricular thrombi have the tendency to embolize, sometimes with dire consequences. Proper management of these thrombi is still controversial. We present a case of an unusual large thrombus, which resolved with anticoagulation therapy alone, giving hope that more invasive intervention can safely be circumvented.

Topics: Adult; Anticoagulants; Cardiomyopathy, Dilated; Drug Administration Schedule; Echocardiography, Transesophageal; Follow-Up Studies; Heart Diseases; Heart Ventricles; Heparin; Humans; Infusions, Intravenous; Male; Severity of Illness Index; Thrombosis; Treatment Outcome; Warfarin

Atrial fibrillation (AF) has been treated with DC shocks delivered transthoracically, but in 5-30% of patients, the procedures fail to restore sinus rhythm (SR). We hypothesized that applying high energy shock waves to the chest may overcome the inadequate penetration of electrical shock to the atrium. The aim of this study was to evaluate the efficacy of higher energy external DC shock for the treatment of refractory AF coexisting with cardiovascular disease using a synchronized double external defibrillator. Fifteen patients (mean age 65 +/- 8) with refractory AF to standard DC cardioversion (CV) underwent higher energy DC shock using a double external defibrillator. Concomitant heart disease was present in all patients. Warfarin and amiodarone (600 mg/day), were administered for at least three weeks duration before DC CV. Sedation was performed with IV midazolam. Two defibrillator paddles were positioned on the anterior and posterior chest wall in a right lateral decubitus position. Defibrillators were synchronized to the R waves and simultaneously 720 joules of energy was administered to the patients. Amiodarone (200 mg/day) was continuously administered after DC shock to maintain SR. Sinus rhythm was obtained in 13 patients. Sinus rhythm was persistent in 11 patients for six months duration. Creatine kinase MB fractions were normal at 4 (22 +/- 4 IU/L) and 12 hours (18 +/- 4 IU/L). None of the patients developed significant hemodynamic compromise or congestive heart failure, higher AV block, stroke, or transient ischemic cerebral events. The results indicate that higher energy DC shock application using a double external defibrillator is an effective and safe method for the cardioversion of refractory AF. We believe this procedure should be performed before internal atrial cardioversion.

Topics: Aged; Amiodarone; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiomyopathy, Dilated; Cardiomyopathy, Hypertrophic; Defibrillators; Electric Countershock; Humans; Middle Aged; Mitral Valve Insufficiency; Rheumatic Heart Disease; Warfarin

A 36-year-old woman developed skin necrosis of the inner thighs following the re-introduction of warfarin after a laparoscopic cholecystectomy. She had a history of liver disease and cardiomyopathy and was on warfarin for 10 years. Warfarin-induced skin necrosis secondary to protein C deficiency was diagnosed. Although warfarin was ceased immediately, the prothrombin time measurements remained prolonged and warfarin levels remained therapeutic. Our patient, who had attached great significance to warfarin therapy, had continued the ingestion of warfarin despite our advice. She required three surgical debridements. Protein C levels, as measured 1 year later, were within normal limits, confirming the transient nature of the acquired deficiency during the acute event. This is the second reported case of warfarin necrosis associated with acquired protein C deficiency.

Topics: Adult; Anticoagulants; Cardiomyopathy, Dilated; Cholelithiasis; Diagnosis, Differential; Drug Eruptions; Female; Humans; Leg; Necrosis; Protein C Deficiency; Warfarin

Sustained or chronic tachyarrhythmia can produce reversible changes of atria or/and ventricles that induce systolic or/and diastolic disfunction, dilatation of heart chambers and progressive symptoms of heart failure. The changes regress after restoration of sinus rhythm. This is the clinical case, when at the beginning of the treatment, primary dilated cardiomyopathy is diagnosed to the patient having chronic atrial fibrillation and later after restoration of sinus rhythm and subsequent reduction of heart chambers as well as improvement of systolic function, past changes was assessed as reversible arrhythmogenic cardiomyopathy.

Topics: Adult; Amiodarone; Angiotensin-Converting Enzyme Inhibitors; Anti-Arrhythmia Agents; Anticoagulants; Antihypertensive Agents; Atrial Fibrillation; Cardiomyopathy, Dilated; Echocardiography; Electric Countershock; Electrocardiography; Follow-Up Studies; Humans; Male; Ramipril; Time Factors; Warfarin

Topics: Cardiomyopathy, Dilated; Fibrinolytic Agents; Humans; Ventricular Dysfunction, Left; Warfarin

Topics: Adolescent; Anticoagulants; Cardiomyopathy, Dilated; Coronary Thrombosis; Heart-Assist Devices; Heparin; Humans; Male; Muscular Dystrophies; Platelet Activation; Warfarin

The aim of the study was to assess the role of oral anticoagulant therapy in patients with dilated cardiomyopathy at risk of embolic complications.. We studied retrospectively two hundred thirty-six patients with dilated cardiomyopathy; sixty-eight cases, with intracavitary thrombosis at cross-sectional echocardiography (17 patients), embolic episodes (22), N.Y.H.A. functional class IV (38), chronic atrial fibrillation (23) or with a combination of such conditions, were treated with warfarin. The cumulative period of exposure to embolic events during follow-up was 814 years in the whole population in the absence of anticoagulant treatment and 213 years during treatment.. The rate of new embolic events was 1.6 and 0 for 100 patients-years for the two periods respectively. The difference was not statistically significant. No clinically relevant haemorrhagic complication was seen during treatment.. Oral anticoagulant therapy may be safely given to subgroups of patients with dilated cardiomyopathy at risk of embolic episodes, following empirical guidelines, provided a careful clinical and laboratory monitoring is carried on, even if no definite conclusion may be obtained about the efficacy of this treatment from a non-randomized study with low rates of new embolic events.

Topics: Administration, Oral; Adolescent; Adult; Aged; Cardiomyopathy, Dilated; Chi-Square Distribution; Drug Evaluation; Embolism; Female; Follow-Up Studies; Hemorrhage; Humans; Male; Middle Aged; Retrospective Studies; Risk Factors; Warfarin

A patient with biventricular thrombus formation in dilated cardiomyopathy suffered massive combined systemic and pulmonary embolization shortly after oral anticoagulation was started. Although this can be coincidental, it can also suggest that the basis of a thrombus may dissolve first with any, including oral, anticoagulation. In unusual conditions surgical removal of thrombi in dilated cardiomyopathy may be a safer alternative.

Topics: Adult; Cardiomyopathy, Dilated; Embolism; Female; Heart Diseases; Humans; Pulmonary Embolism; Thrombosis; Warfarin

Dilated cardiomyopathy is associated with thromboembolic complications, which correlate poorly, however, with a visible left ventricular thrombus. Therefore, this study was performed to assess whether an abnormality of platelet function in vivo can be detected in patients with dilated cardiomyopathy. Platelet survival was measured after autologous labeling with indium-111 oxine in 28 patients with dilated cardiomyopathy and angiographically normal coronary arteries (mean ejection fraction 21 +/- 9% [standard deviation], range 4 to 39%) and in nine patients with coronary artery disease and similar left ventricular dysfunction (mean ejection fraction 21 +/- 10%). Plasma levels of beta-thromboglobulin and platelet factor 4 were measured in patients with idiopathic cardiomyopathy (n = 15) and platelet scintigraphic images of the heart (n = 24) were obtained in subsets of both patient groups. Platelet survival was significantly and similarly shortened in patients with idiopathic and ischemic cardiomyopathy (67 +/- 34 and 55 +/- 24 h, respectively) compared to controls (209 +/- 9 h, n = 12; p less than 0.001). Of the two platelet-specific proteins, beta-thromboglobulin was increased in the patients compared with controls (42 +/- 17 versus 22 +/- 6 ng/ml, p less than 0.001). Platelet scintigraphy 24 h (n = 24) and/or 48 h (n = 9) after labeling showed a diffuse pattern of enhanced platelet uptake over the heart which varied in intensity among patients, but which was never seen in controls (n = 6). This increased platelet uptake was similar in patients with idiopathic and ischemic cardiomyopathy but did not correlate with either ejection fraction or cardiothoracic ratio.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; beta-Thromboglobulin; Blood Platelets; Cardiomyopathy, Dilated; Cell Survival; Female; Humans; Indium Radioisotopes; Male; Middle Aged; Platelet Factor 4; Radionuclide Imaging; Warfarin

Topics: Adult; Cardiomyopathy, Dilated; Echocardiography; Heart Diseases; Heparin; Humans; Male; Thrombosis; Time Factors; Warfarin

Topics: Anticoagulants; Atrial Fibrillation; Blood Coagulation; Cardiomyopathy, Dilated; Coronary Disease; Heart Diseases; Heparin; Humans; Platelet Aggregation Inhibitors; Thromboembolism; Warfarin

The relationship between left ventricular thrombus and left ventricular dynamics in dilated cardiomyopathy (DCM) was studied by echocardiography and postmortem examination. The subjects were 57 patients with DCM, 40 were survival patients examined by echocardiography and 17 were autopsy patients. Systemic or pulmonary embolism occurred in 10 of 57 patients, 4 of 40 survival patients and 6 of 17 autopsy patients. Intracardiac thrombus was detected in 11 of 40 survival patients and was found in 8 of 17 autopsy patients. Left ventricular segmental wall motion abnormalities were observed in all 40 patients examined by two-dimensional echocardiography and apical dyskinesis or akinesis was observed more frequently in patients with left ventricular thrombus than in patients without left ventricular thrombus. Of 33 patients examined by pulsed Doppler echocardiography, Doppler ejection flow signals in the apical long axis view were recorded in 9% at the apex, in 17% at the middle portion and in 57% at the portion near the interventricular septal center. The signals at the portion near the interventricular septal center were recorded in only 2 patients with left ventricular thrombus but in 66% of patients without left ventricular thrombus. Systemic or pulmonary embolism and intracardiac thrombus occurred less frequently in patients treated with warfarin than in patients without warfarin. These results indicate that endomyocardial and blood flow disorders of the left ventricle play important roles in the occurrence of left ventricular thrombus and that anticoagulant therapy is useful for the prevention of systemic or pulmonary embolism and cardiac thrombus.

Topics: Adult; Cardiomyopathy, Dilated; Coronary Disease; Coronary Thrombosis; Female; Heart; Heart Ventricles; Humans; Male; Middle Aged; Stroke Volume; Warfarin

Topics: Adult; Axillary Vein; Cardiomyopathy, Dilated; Female; Follow-Up Studies; Furosemide; Heparin; Humans; Potassium; Pregnancy; Puerperal Disorders; Thrombosis; Time Factors; Warfarin