Key Points
- To evaluate the efficacy and clinical outcomes of long-term antithrombotic therapy on thromboembolism incidence in patients with chronic heart failure.
- Multicenter, randomized, double-blind, placebo-controlled trial enrolling 197 heart failure patients with left ventricular ejection fraction <35% followed for 312 patient-years.
- Patients with ischemic heart disease were randomized to receive aspirin 325 mg or warfarin, while patients with dilated cardiomyopathy were randomized to warfarin or placebo.
- Embolic event incidence was 2.2 per 100 patient-years with no statistically significant difference between groups, and no peripheral or pulmonary emboli were reported.
- Incidence rates of myocardial infarction, hospitalization, heart failure exacerbation, hemorrhage, and death did not differ significantly across treatment groups.
- Echocardiographic follow-up at 2 years demonstrated an overall increase in left ventricular ejection fraction from 28.2 ± 6% to 30.3 ± 7% (p < 0.05), which was most pronounced in dilated cardiomyopathy patients receiving warfarin (26.8 ± 5.3% to 30.7 ± 10%, p < 0.05).
Structured PICO
Does antithrombotic therapy (aspirin or warfarin) reduce the incidence of thromboembolism in patients with chronic heart failure (EF <35%)?
PPopulation197 patients with chronic heart failure (EF <35%), including patients with Ischaemic Heart Disease and Dilated Cardiomyopathy (DCM).
IInterventionAspirin 325mg or warfarin for patients with Ischaemic Heart Disease; warfarin for patients with Dilated Cardiomyopathy.
CComparatorWarfarin (active comparator for Ischaemic Heart Disease) or placebo (for Dilated Cardiomyopathy).
OOutcomeIncidence of thromboembolism (embolic events).hard clinical
Long-term antithrombotic treatment with aspirin or warfarin does not significantly affect the incidence of embolic events in patients with chronic heart failure, as these events are rare regardless of treatment.