43
Renal Replacement Therapy—Ultrafiltration
Î Ultrafiltration may be considered for patients with obvious volume
overload to alleviate congestive symptoms and fluid weight. (IIb-B)
Î Ultrafiltration may be considered for patients with refractory
congestion not responding to medical therapy. (IIb-C)
Parenteral Therapy in Hospitalized HF
Î If symptomatic hypotension is absent, intravenous nitroglycerin,
nitroprusside, or nesiritide may be considered as an adjuvant to
diuretic therapy for relief of dyspnea in patients admitted with acute
decompensated HF. (IIb-A)
Venous Thromboembolism Prophylaxis in Hospitalized Patients
Î A patient admitted to the hospital with decompensated HF should
receive venous thromboembolism prophylaxis with an anticoagulant
medication if the risk–benefit ratio is favorable. (I-B)
Arginine Vasopressin Antagonists
Î In patients hospitalized with volume overload, including HF, who have
persistent severe hyponatremia and are at risk for or having active
cognitive symptoms despite water restriction and maximization of
GDMT, vasopressin antagonists may be considered in the short term to
improve serum sodium concentration in hypervolemic, hyponatremic
states with either a V
2
receptor–selective or a nonselective
vasopressin antagonist. (IIb-B)
Figure 5. Classification of Patients Presenting With Acute
Decompensated HF
Congestion at rest?
(eg, orthopnea, elevated jugular venous pressure, pulmonary rales,
S
3
gallop, edema)
Low
perfusion
at
rest?
(eg,
narrow
pulse
pressure,
cool
extremities,
hypotension)
NO
NO YES
YES
Warm and dry Warm and wet
Cold and dry Cold and wet
Adapted from Nohria A, et al. JAMA. 2002;287:628-640.
