Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature
Abstract Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aeti...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2021-12-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.13643 |
| _version_ | 1828795267536650240 |
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| author | Razvan I. Radu Tuvia Ben Gal Magdy Abdelhamid Elena‐Laura Antohi Marianna Adamo Andrew P. Ambrosy Oliviana Geavlete Yuri Lopatin Alexander Lyon Oscar Miro Marco Metra John Parissis Sean P. Collins Stefan D. Anker Ovidiu Chioncel |
| author_facet | Razvan I. Radu Tuvia Ben Gal Magdy Abdelhamid Elena‐Laura Antohi Marianna Adamo Andrew P. Ambrosy Oliviana Geavlete Yuri Lopatin Alexander Lyon Oscar Miro Marco Metra John Parissis Sean P. Collins Stefan D. Anker Ovidiu Chioncel |
| author_sort | Razvan I. Radu |
| collection | DOAJ |
| description | Abstract Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis. |
| first_indexed | 2024-12-12T04:00:57Z |
| format | Article |
| id | doaj.art-d655f69a7f10400792deeb84af7d8578 |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-12-12T04:00:57Z |
| publishDate | 2021-12-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-d655f69a7f10400792deeb84af7d85782022-12-22T00:39:03ZengWileyESC Heart Failure2055-58222021-12-01864717473610.1002/ehf2.13643Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literatureRazvan I. Radu0Tuvia Ben Gal1Magdy Abdelhamid2Elena‐Laura Antohi3Marianna Adamo4Andrew P. Ambrosy5Oliviana Geavlete6Yuri Lopatin7Alexander Lyon8Oscar Miro9Marco Metra10John Parissis11Sean P. Collins12Stefan D. Anker13Ovidiu Chioncel14ICCU Department Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’ Bucharest RomaniaDepartment of Cardiology, Rabin Medical Center (Beilinson Campus), Sackler Faculty of Medicine Tel Aviv University Tel Aviv IsraelCardiology Department, Kasr Alainy School of Medicine Cairo University Cairo EgyptICCU Department Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’ Bucharest RomaniaCardiothoracic Department, Civil Hospitals and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalyDepartment of Cardiology Kaiser Permanente San Francisco Medical Center San Francisco CA USAICCU Department Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’ Bucharest RomaniaCardiology Centre Volgograd Medical University Volgograd Russian FederationCardio‐Oncology Service Royal Brompton Hospital and Imperial College London London UKEmergency Department, Hospital Clínic de Barcelona University of Barcelona Barcelona SpainCardiology, Cardiothoracic Department, Civil Hospitals; Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health University of Brescia Brescia ItalySecond Department of Cardiology, Attikon University Hospital National and Kapodistrian University of Athens Athens GreeceDepartment of Emergency Medicine; Vanderbilt University Medical Centre Nashville TN USADepartment of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin Charité—Universitätsmedizin Berlin Berlin GermanyICCU Department Emergency Institute for Cardiovascular Diseases ‘Prof. Dr. C.C. Iliescu’ Bucharest RomaniaAbstract Cardiogenic shock (CS) is a complex multifactorial clinical syndrome, developing as a continuum, and progressing from the initial insult (underlying cause) to the subsequent occurrence of organ failure and death. There is a large phenotypic variability in CS, as a result of the diverse aetiologies, pathogenetic mechanisms, haemodynamics, and stages of severity. Although early revascularization remains the most important intervention for CS in settings of acute myocardial infarction, the administration of timely and effective antithrombotic therapy is critical to improving outcomes in these patients. In addition, other clinical settings or non‐acute myocardial infarction aetiologies, associated with high thrombotic risk, may require specific regimens of short‐term or long‐term antithrombotic therapy. In CS, altered tissue perfusion, inflammation, and multi‐organ dysfunction induce unpredictable alterations to antithrombotic drugs' pharmacokinetics and pharmacodynamics. Other interventions used in the management of CS, such as mechanical circulatory support, renal replacement therapies, or targeted temperature management, influence both thrombotic and bleeding risks and may require specific antithrombotic strategies. In order to optimize safety and efficacy of these therapies in CS, antithrombotic management should be more adapted to CS clinical scenario or specific device, with individualized antithrombotic regimens in terms of type of treatment, dose, and duration. In addition, patients with CS require a close and appropriate monitoring of antithrombotic therapies to safely balance the increased risk of bleeding and thrombosis.https://doi.org/10.1002/ehf2.13643Cardiogenic shockAntithrombotic therapyAntiplatelet therapyAnticoagulation therapy |
| spellingShingle | Razvan I. Radu Tuvia Ben Gal Magdy Abdelhamid Elena‐Laura Antohi Marianna Adamo Andrew P. Ambrosy Oliviana Geavlete Yuri Lopatin Alexander Lyon Oscar Miro Marco Metra John Parissis Sean P. Collins Stefan D. Anker Ovidiu Chioncel Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature ESC Heart Failure Cardiogenic shock Antithrombotic therapy Antiplatelet therapy Anticoagulation therapy |
| title | Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature |
| title_full | Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature |
| title_fullStr | Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature |
| title_full_unstemmed | Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature |
| title_short | Antithrombotic and anticoagulation therapies in cardiogenic shock: a critical review of the published literature |
| title_sort | antithrombotic and anticoagulation therapies in cardiogenic shock a critical review of the published literature |
| topic | Cardiogenic shock Antithrombotic therapy Antiplatelet therapy Anticoagulation therapy |
| url | https://doi.org/10.1002/ehf2.13643 |
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