Is there a role for anticoagulation in a patient who has nonischemic cardiomyopathy with low ejection fraction?
—Girish Sharma, MD, Rockville, Conn.

Anytime the left ventricle is not contracting well (left ventricular ejection fraction <25%), whether as the result of a diffuse process, as in this patient, or with localized aneurysms, as in coronary artery disease (especially in the setting of congestive heart failure), consideration has to be given to anticoagulation with warfarin. The aim is to prevent thrombus formation in the left ventricle and subsequent embolization, which can include cerebrovascular accidents, with all their catastrophic consequences. However, unless there has been evidence of thromboembolic events clinically or left ventricular thrombus by echocardiogram, the potential benefits of anticoagulation may be limited in this type of patient, and there is no consensus about its use (Eur Heart J.2005;26:1115-1140).
—Peter F. Cohn, MD (124-4)