Anticoagulant therapy for venous thrombosis in patients with concomitant cardiac pathology

Venous thromboembolic events (VTE) can occur at any time in life, but the incidence of VTE increases with age. A progressive increase in the annual incidence of both deep vein thrombosis (DVT) and pulmonary embolism (PE), both individually and cases of VTE in the aggregate are reported after age 50 years. Patients with multiple clinical risk factors for both thrombotic and/or ischemic events, as well as bleeding, are one of the most challenging categories in real-world clinical practice. The choice of the optimal antithrombotic therapy volume is often not based on the established algorithms and approved guidelines. This review examines the features of the anticoagulant therapy for venous thrombosis occurred in patients with concomitant cardiovascular diseases, especially in atrial fibrillation, coronary heart disease, and hypertension. To assess the current status of the issue, we analysed published literature from the PubMed/MEDLINE and eLIBRARY.RU databases, as well as clinical guidelines of the European Society of Cardiology, the European Society for Vascular Surgery, the American Heart Association, the American College of Cardiology, and national clinical guidelines on the management of deep vein thrombosis, atrial fibrillation, and coronary heart disease. This review discusses the nuances of choosing a treatment regimen, taking into account not only the clinical features of the incident venous events, but also the cardiac indications for the use of anticoagulants and/or antiplatelet agents. Options for the optimal duration of anticoagulation and anticoagulant agent dosages including those used when planning the prolonged therapy with a good balance between risks and benefits are considered. We also evaluated the clinical feasibility and risk of hemorrhagic complications associated with the combined use of anticoagulants and antiplatelet agents in patients with cardiac multimorbidity.

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