Heart Failure Linked to Increased Risk of VTE

Heart failure (HF) is an independent risk factor for venous thromboembolism (VTE), according to a study published in Korean Circulation Journal.

HF often causes immobility and bedridden status, thus augmenting the short-term risk of venous thromboembolism (VTE), including deep vein thrombosis (DVT), pulmonary embolism (PE); and this may portend to worse prognoses.

“A previous meta-analysis showed that the in-hospitalized incidence of VTE in patients with HF was 2.66% and the risk of VTE in in-hospitalized HF patients (<60 days) was almost 70% higher compared with non-HF patients. “Clinical trials revealed that short-term thromboprophylaxis could be beneficial in HF patients,” the researchers wrote. “However, the risk of VTE in out-patients with HF in a long-term period is still controversial, which leads to unclear recommendations for long-term treatment in HF patients. Given these inconsistencies, we synthesized available data to quantify the risk of VTE in HF in long-term follow-up time.”

To conduct this study, researchers investigated the risk of VTE, PE, and DVT in patients with HF before April 15, 2020, in the following databases: PubMed, MEDLINE, and Embase. Inclusion criteria was defined as cohort studies and post hoc analysis of RCTs if they reported relative risk of VTE, DVT or PE in patients with HF in more than 3-month follow-up period. In total, the analysis identified 31 studies comprised of over 530,641 HF patients.

According to the results, patients with HF had increased risk of both VTE (risk ratio [RR]=1.57, 95% confidence interval [CI],1.34-1.84), and PE (RR=2.00, 95% CI, 1.38-2.89). However, the researchers noted, the risk of DVT was not significantly increased in HF patients (RR=1.33, 95% CI,0.67-2.63). The results of a subgroup analysis revealed that patients with chronic HF (RR=1.54, 95% CI, 1.32-1.80) had a higher risk of VTE than those with acute HF (RR=0.95, 95% CI, 0.68-1.32).

“These results remind us that we should not neglect the risk of those patients with uncommon venous thrombus especially for those who are frequently rehospitalized, with long-term in-hospitalized stay or receiving catheter therapy. Another explanation is that DVT is hard for some patients to recognize and is often neglected by physicians because it could be asymptomatic. Nonetheless, symptoms of DVT are similar to symptoms of HF, so physicians may mistake them as worsening HF without realizing DVT,” the researchers wrote.

The investigators concluded that: “HF was an independent risk for VTE and PE but not DVT in the long-term follow-up period. Patients with chronic HF were prone to have a higher risk of VTE Further designated and prospective studies are needed for our better understandings of impacts of HF on the risk of VTE, PE and, DVT. RCTs about anticoagulation therapy in HF patients to prevent VTE, PE, and DVT are also needed for better management of HF patients.”