Oral Anticoagulation Therapy in Heart Failure Patients in Sinus Rhythm: A Systematic Review and Meta-Analysis

Giuseppe Rengo; Gennaro Pagano; Alessandro Squizzato; Lorenzo Moja; Grazia Daniela Femminella; Claudio de Lucia; Klara Komici; Valentina Parisi; Gianluigi Savarese; Nicola Ferrara; Pasquale Perrone Filardi; Dario Leosco

doi:10.1371/journal.pone.0052952

January 2, 2013PLoS ONEOpen Access

Oral Anticoagulation Therapy in Heart Failure Patients in Sinus Rhythm: A Systematic Review and Meta-Analysis

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Why the study?

Does oral anticoagulation therapy reduce mortality compared to antiplatelet treatment in heart failure patients in sinus rhythm?

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?

P

Population

3,663 adults with heart failure (both ischemic and non-ischemic) in sinus rhythm (without atrial fibrillation) pooled from 4 RCTs.

I

Intervention

Oral anticoagulant therapies (warfarin, target INR 2.0-3.5 depending on trial) for a mean duration of 20 to 42 months.

C

Comparator

Antiplatelet treatment (aspirin 162 mg to 325 mg).

O

Outcome

Overall 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)

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Implication

No mortality benefit argues against routine OATs in HF with sinus rhythm; confirms stroke reduction offset by doubled major bleeding.

Abstract

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Discussion

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Cite This Study

Rengo et al. (2013) studied this question.

synapsesocial.com/papers/6a226f40b04f494b2753e1cc https://doi.org/10.1371/journal.pone.0052952

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Oral Anticoagulation Therapy in Heart Failure Patients in Sinus Rhythm: A Systematic Review and Meta-Analysis

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Oral Anticoagulation Therapy in Heart Failure Patients in Sinus Rhythm: A Systematic Review and Meta-Analysis

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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