Risk-benefit Profile of Warfarin vs. Aspirin in Patients with Heart Failure and Sinus Rhythm: A Meta-Analysis.
Circ Heart Fail. 2012 Dec 21;
Authors: Lee M, Saver JL, Hong KS, Wu HC, Ovbiagele B
Abstract
BACKGROUND: -The risk-benefit profile of warfarin versus aspirin for patients with heart failure in normal sinus rhythm has not been definitively established. Our objective was to evaluate the overall comparative effects of warfarin and aspirin in patients with heart failure and normal sinus rhythm. METHODS AND RESULTS: -Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, and Clinicaltrials.gov from 1966 to June 2012 were searched to identify relevant studies. We included randomized controlled trials that included comparison of warfarin vs. aspirin, and composite endpoint of death or stroke separately for active treatment and control groups. Summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated using random-effects models. The search identified 4 randomized controlled trials of warfarin vs. aspirin therapy, enrolling 3663 patients. There was no significant difference between the two treatments for the primary endpoint (warfarin vs. aspirin: RR 0.94, 95% CI: 0.84 to 1.06, p=0.31). Warfarin (vs. aspirin) was associated with lower risk of any stroke (RR 0.56, 95% CI: 0.38 to 0.82, p=0.003) and ischemic stroke (RR 0.45, 95% CI: 0.24 to 0.86, p=0.02) but had a neutral effect on death (RR 1.01, 95% CI: 0.89-1.14, p=0.89) and a higher risk of major bleeding (RR 1.95, 95% CI 1.37 to 2.76, p=0.0002). CONCLUSIONS: -Compared to aspirin, warfarin does not provide benefit in the prevention of stroke and death among patients with heart failure in sinus rhythm, but raises the risk of major bleeding; and therefore its use in these patients is not justified.
PMID: 23264446 [PubMed - as supplied by publisher]