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Direct oral anticoagulants across the heart failure spectrum: the precision medicine era

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Abstract

Heart failure (HF) is characterized by a pro-thrombotic state, which might aggravate its morbidity and, consequently, mortality. Several and commonly observed comorbidities, such as coronary artery disease, atrial fibrillation (AF), renal dysfunction, and diabetes often complicate HF, increasing the thromboembolic risk. In the past decade, direct oral anticoagulants (DOACs) have been approved for the treatment and prevention of stroke and embolic events in patients with nonvalvular AF. Due to their lower bleeding risk, these drugs are frequently used instead of warfarin; however, some controversies exist on their use in HF patients with or without comorbidities. Indeed, the management of anticoagulation in HF patients with underlying conditions is poorly investigated since these patients are underrepresented or excluded from randomized controlled trials. The aim of this research is to review current evidence on the use of DOACs in HF patients, also discussing their specific use in different clinical scenarios.

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Authors and Affiliations

  1. Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy

    Stefania Paolillo & Pasquale Perrone Filardi

  2. Mediterranea Cardiocentro, Naples, Italy

    Stefania Paolillo

  3. Division of Cardiology, Regina Montis Regalis Hospital, ASLCN-1, Via S. Rocchetto, 99, 12084, Mondovì, CN, Italy

    Gaetano Ruocco

  4. Cardiovascular Diseases Unit, Department of Internal Medicine, University of Siena, Siena, Italy

    Alberto Palazzuoli

  5. Department of Translational Medical Sciences, Federico II University, Naples, Italy

    Carlo Gabriele Tocchetti

  6. Cardiology Section, Department of Clinical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy

    Savina Nodari, Carlo Lombardi & Marco Metra

  7. Department of Cardiology, University of Foggia, Foggia, Italy

    Michele Correale

Authors
  1. Stefania Paolillo
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  2. Gaetano Ruocco
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  3. Pasquale Perrone Filardi
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  4. Alberto Palazzuoli
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  5. Carlo Gabriele Tocchetti
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  6. Savina Nodari
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  7. Carlo Lombardi
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  8. Marco Metra
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  9. Michele Correale
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on behalf of “Right and Left Heart Failure Study Group” of the Italian Society of Cardiology

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Correspondence to Gaetano Ruocco.

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Stefania Paolillo and Gaetano Ruocco share the first authorship.

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Paolillo, S., Ruocco, G., Filardi, P.P. et al. Direct oral anticoagulants across the heart failure spectrum: the precision medicine era. Heart Fail Rev 27, 135–145 (2022). https://doi.org/10.1007/s10741-020-09994-0

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  • DOI: https://doi.org/10.1007/s10741-020-09994-0

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