Anticoagulation in Patients with Heart Failure with Reduced Ejection Fraction and Normal Sinus Rhythm

Although heart failure with reduced ejection fraction (HFrEF) and normal sinus rhythm is associated with an increased risk for thromboembolic events, the evidence has generally not supported the use of anticoagulation. Accordingly, the guidelines consider anticoagulation in this group as class III (i.e., no benefit and the possibility of harm). Since the publication of the guidelines, researchers published the findings of a trial of rivaroxaban in patients with coronary artery disease and recent worsening heart failure (COMMANDER-HF) that adds information, including the use of a non–vitamin K oral anticoagulant. Now, investigators have conducted a meta-analysis of all relevant trials to determine the effect of anticoagulation in patients wi…