Key Points
- This research aims to evaluate the effectiveness and safety of oral anticoagulation therapies compared to antiplatelet treatments in heart failure patients in sinus rhythm.
- Conducted a systematic review of randomized controlled trials (RCTs) with 3663 patients.
- Engaged in a meta-analysis to compare outcomes of oral anticoagulants and antiplatelet treatments.
- Included patients with both ischemic and non-ischemic heart failure.
- No significant difference in mortality between oral anticoagulation therapy and antiplatelet treatment (OR 1.01, 95% CI 0.86 to 1.19).
- Oral anticoagulants reduced ischemic stroke risk compared to antiplatelet treatment (OR 0.49, 95% CI 0.32 to 0.74).
- Oral anticoagulants increased major bleeding risk compared to antiplatelet drugs (OR 2.01, 95% CI 1.40 to 2.88).
Structured PICO
Does oral anticoagulation therapy reduce mortality compared to antiplatelet treatment in heart failure patients in sinus rhythm?
PPopulation3,663 adults with heart failure (both ischemic and non-ischemic) in sinus rhythm (without atrial fibrillation) pooled from 4 RCTs.
IInterventionOral anticoagulant therapies (warfarin, target INR 2.0-3.5 depending on trial) for a mean duration of 20 to 42 months.
CComparatorAntiplatelet treatment (aspirin 162 mg to 325 mg).
OOutcomeOverall mortality.hard clinical
In heart failure patients in sinus rhythm, warfarin does not improve survival compared to aspirin, and its reduction in ischemic stroke is offset by a doubled risk of major bleeding.
Limitations
- Not carried out on individual patients data exploring subgroups with higher thromboembolic risk
- Too small sample size and too short follow up period resulting in a low number of events
- Exclusion of gray literature
- Aspirin dosage differences among trials (WATCH trial used lower dose)