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07-05-2012 | Cardiology | Article

Aspirin, warfarin equally effective for heart failure


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MedWire News: There is no significant difference in the risk for ischemic stroke, intracerebral hemorrhage, or death with warfarin or aspirin for patients with heart failure who are in sinus rhythm, a study shows.

This means there is "no compelling reason" to use warfarin rather than aspirin in such patients, say Shunichi Homma (Columbia University Medical Center, New York, USA) and team in the NEJM.

They followed 2305 patients with sinus rhythm and a reduced left ventricular ejection fraction (LVEF; ≤35%) over a mean follow-up period of 3.5 years. The primary outcome was the time to the first event in a composite endpoint of ischemic stroke, intracerebral hemorrhage, or death from any cause.

The rate of the primary outcome was 7.47 events per 100 patient-years in the warfarin group compared with 7.93 in the aspirin group. However, this difference was not significant.

Time-varying analysis revealed that the hazard ratio with warfarin changed over time, slightly favoring warfarin over aspirin by the fourth year of follow up, but this finding was only marginally significant (p=0.046).

Compared with aspirin, warfarin was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period, at 1.36 versus 0.72 events per 100 patient-years, corresponding to a hazard ratio of 0.52 (p=0.005).

The rate of major hemorrhage was significantly higher in the warfarin group as compared with the aspirin group, at 1.78 versus 0.87 events per 100 patient-years (p<0.001).

By contrast, the rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups.

"Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs," commented Homma in a press statement.

"However, given the convenience and low cost of aspirin, many may go this route."

Walter Koroshetz, from the National Institute for Neurological Disorders and Stroke, which funded the study, added: ""With at least 6 million Americans - and many more around the world - suffering from heart failure, the results of the WARCEF study will have a large public health impact.

"Patients and their physicians now have critical information to help select the optimum treatment approach. The key decision will be whether to accept the increased risk of stroke with aspirin, or the increased risk of primarily gastrointestinal hemorrhage with warfarin."

MedWire ( is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2012

By Piriya Mahendra

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