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Review

Anticoagulation Therapies and microRNAs in Heart Failure

Cardiovascular Research Center, IRCCS San Raffaele Hospital, 20132 Milan, Italy
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Author to whom correspondence should be addressed.
Biomolecules 2025, 15(10), 1411; https://doi.org/10.3390/biom15101411
Submission received: 22 August 2025 / Revised: 24 September 2025 / Accepted: 29 September 2025 / Published: 3 October 2025

Abstract

Heart failure (HF) remains a major cause of mortality despite the advances in pharmacological treatment. Anticoagulation therapies, including Clopidogrel, Aspirin, Warfarin, and novel oral anticoagulants (NOACs) such as Apixaban, Rivaroxaban, Edoxaban, and Dabigatran, are frequently administered to HF patients to prevent thromboembolism and adverse, life-threatening outcomes (e.g., stroke and myocardial infarction). In these settings, drug resistance and variability in responsivity to therapeutic approaches are challenging issues. Recent studies suggest that non-coding RNAs, particularly microRNAs (miRs) may play a modulatory role in HF therapy context, affecting drug efficacy. Specific miRs have been associated with resistance to Clopidogrel (e.g., miR-223 and miR-26a), Aspirin (e.g., miR-19b-1-5p and miR-92a) and Warfarin (e.g., miR-133 and miR-137). Moreover, Digoxin, a cardiac glycoside acting also over bleeding risk, upregulates miR-132, which is involved in HF-associated cardiac alteration and hypertrophy. Evidence linking miR expression to NOAC pharmacodynamics, cardiac remodeling and regulation of the coagulation is growing. These findings highlight the need of deeply harnessing the potential of miRs as predictive biomarkers or therapeutic targets in HF. Improving the knowledge on the relationship between miR and anticoagulant drugs in HF patients will contribute to personalization of the anticoagulant therapies, aimed at enhancing patient responsivity and minimizing adverse effects, ultimately improving patient life quality.
Keywords: heart failure (HF); anticoagulation drugs; Clopidogrel Aspirin; Warfarin; Apixaban; Rivaroxaban; Edoxaban; Dabigatran; Digoxin; Ivabradine; microRNAs (miRs) heart failure (HF); anticoagulation drugs; Clopidogrel Aspirin; Warfarin; Apixaban; Rivaroxaban; Edoxaban; Dabigatran; Digoxin; Ivabradine; microRNAs (miRs)

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MDPI and ACS Style

Spartano, L.; Lombardi, M.; Foglieni, C. Anticoagulation Therapies and microRNAs in Heart Failure. Biomolecules 2025, 15, 1411. https://doi.org/10.3390/biom15101411

AMA Style

Spartano L, Lombardi M, Foglieni C. Anticoagulation Therapies and microRNAs in Heart Failure. Biomolecules. 2025; 15(10):1411. https://doi.org/10.3390/biom15101411

Chicago/Turabian Style

Spartano, Lucia, Maria Lombardi, and Chiara Foglieni. 2025. "Anticoagulation Therapies and microRNAs in Heart Failure" Biomolecules 15, no. 10: 1411. https://doi.org/10.3390/biom15101411

APA Style

Spartano, L., Lombardi, M., & Foglieni, C. (2025). Anticoagulation Therapies and microRNAs in Heart Failure. Biomolecules, 15(10), 1411. https://doi.org/10.3390/biom15101411

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