Systolic Left Ventricular Dysfunction
ÎFor patients with systolic LV dysfunction without established CAD and no LV thrombus, the ACCP suggests NOT to use antiplatelet therapy or warfarin (2-C).
Remark: Patients who place a high value on an uncertain reduction in stroke and a low value on avoiding an increased risk of GI bleeding are likely to choose warfarin.
ÎFor patients with systolic LV dysfunction and identified acute LV thrombus (eg, Takotsubo cardiomyopathy) without established CAD, the ACCP suggests moderate-intensity warfarin (INR 2.0-3.0) for at least 3 months (2-C).
ÎFor patients with systolic LV dysfunction and established CAD, recommendations are as per established ACCP CAD recommendations.
Table 1. Drugs Class/Agent (Brand)
Antiplatelet Aspirin
Clopidogrel (Plavix® Prasugrel (Effient® Ticagrelor (Brilinta™
) ) VKA
Warfarin (Coumadin®
, Jantoven® )a ) PO
Phosphodiesterase III inhibitor Cilostazol (Pletal®
PO Adjust to INR 100 mg twice daily a FDA-approved to reduce symptoms of intermittent claudication. MedCalc - Framingham Heart Risk )
Route
PO PO PO PO
Dosea
75-100 mg once daily 75 mg once daily
60 mg, then 10 mg once daily 180 mg, then 90 mg twice daily
