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Stroke in patients with heart failure and reduced left ventricular ejection fraction

P M Pullicino1, J L Halperin, J L Thompson

  • 1Department of Neurology, State University of New York at Buffalo, USA.

Neurology
|February 11, 2000
PubMed

Insights

Warfarin may reduce stroke and mortality in heart failure patients with reduced ejection fraction (EF). However, definitive evidence is lacking, necessitating further clinical trials to compare warfarin and aspirin efficacy.

Area of Science:

  • Cardiology
  • Neurology
  • Pharmacology

Background:

  • Cardiac failure is linked to cardioembolic stroke and increased mortality.
  • Warfarin is commonly prescribed for patients with reduced left ventricular ejection fraction (EF), despite a lack of randomized trial data supporting its benefit.

Purpose of the Study:

  • To review the incidence of stroke and mortality in heart failure patients with reduced EF.
  • To evaluate the impact of antithrombotic agents on stroke and mortality.
  • To examine the design of the WATCH and WARCEF trials comparing warfarin and antiplatelet agents in low EF populations.

Main Methods:

  • Conducted a literature review on stroke and mortality in heart failure.
  • Analyzed data on antithrombotic effects in reduced EF patients.
  • Reviewed proposed trial designs (WATCH, WARCEF) for warfarin versus antiplatelet therapy.

Main Results:

  • Stroke risk escalates with decreasing EF; mortality risk rises with heart failure severity (NYHA class).
  • Existing data suggest warfarin might lower stroke and mortality in reduced EF, but conclusive evidence is absent.
  • Combined stroke and death endpoints, as in WARCEF and WATCH, are suitable for assessing antithrombotic effects in heart failure.

Conclusions:

  • The superiority of warfarin over aspirin in mitigating stroke and mortality in patients with low ejection fraction remains an open clinical question.
  • Prospective evaluation is crucial to determine optimal antithrombotic therapy for heart failure patients with reduced EF.
Abstract

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