In this article, we will discuss the Role of Anticoagulants and Beta-adrenergic receptors blocker in Congestive Heart Failure. So, let’s get started.
Anticoagulation: Congestive heart failure is important risk factor for thromboembolism especially in the presence of atrial fibrillation and in patients with recent AMI, hence these group of patients maybe anticoagulated with warfarin for 3 months, otherwise anticoagulants should not be used in patients with normal sinus rhythm without history of thromboembolism.
Beta-adrenergic receptors blocker: So far beta-blockers were considered to be contraindicated because of blunting of sympathetic and catecholamine response in CHF, but recent clinical trials have shown this blunting response to have beneficial effects. Out of several beta-blockers, only carvedilol, bisoprolol and nebivolol have been approved by FDA for management of class II or III chronic heart failure. Treatment with beta blockers should be initiated in very low doses followed by gradual increments in those if lower doses have been well-tolerated. For example, therapy should be started at a dose of 3.125 mg of carvedilol twice-daily, 12.5 to 25 mg sustained release metoprolol, 1.25 to 2.5 mg bisoprolol daily followed by doubling the dose after 2 to 4 weeks. Patients should be monitored closely for evidence of hypotension, bradycardia, fluid retention (weight) or worsening heart failure. There is strong recommendation that stable patients with any grade of heart failure (mild, moderate or severe) should be treated with the beta-blockers unless there is any contraindication.