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Warfarin, Aspirin Comparable in Patients With Heart Failure

No significant overall difference in primary outcome in those with heart failure who are in sinus rhythm

WEDNESDAY, May 2 (HealthDay News) -- For heart failure patients with reduced left ventricular ejection fraction (LVEF) who are in sinus rhythm, there is no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin, according to a study published online May 2 in the New England Journal of Medicine.

Shunichi Homma, M.D., from the Columbia University Medical Center in New York City, and colleagues followed 2,305 patients in sinus rhythm with reduced LVEF for up to six years to assess whether warfarin or aspirin therapy is superior. The time to first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or all-cause death was measured as the primary outcome.

The researchers found no significant difference between the groups in the rate of the primary outcome: 7.47 events per 100 patient-years in the warfarin group versus 7.93 in the aspirin group (P = 0.40). In a time-varying analysis, there was a slight but marginally significant benefit for warfarin over time by the fourth year of follow-up (P = 0.046). Compared with aspirin, warfarin was associated with a significant reduction in the rate of ischemic stroke (0.72 versus 1.36 events per 100 patient-years; P = 0.005) and an increase in the rate of major hemorrhage (1.78 versus 0.87 events over 100 patient-years; P < 0.001). There was no significant difference in the rates of intracerebral and intracranial hemorrhage between the two groups.

"Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin," the authors write. "The choice between warfarin and aspirin should be individualized."

Several authors disclosed financial ties to the pharmaceutical industry.

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