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Anticoagulation for heart failure in sinus rhythm.
1Haemostasis Thrombosis and Vascular Biology Unit, University Department of Medicine, City Hospital, Dudley Road, Birmingham, UK, B18 7QH. g.y.h.lip@bham.ac.uk
The Cochrane Database of Systematic Reviews
|November 1, 2001
Summary
Oral anticoagulation may reduce deaths and cardiovascular events in heart failure patients. However, current evidence does not support routine use in those with sinus rhythm, pending further research.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Patients with chronic heart failure face risks of thromboembolic and coronary ischemic events.
- Oral anticoagulation is established for heart failure with atrial fibrillation, but its use varies in the broader heart failure population.
Purpose of the Study:
- To evaluate if long-term oral anticoagulation reduces all-cause mortality and major thromboembolic events in heart failure patients compared to placebo.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and non-randomized studies.
- Meta-analysis of data from RCTs where appropriate.
- Inclusion criteria: adults with heart failure, treatment duration of at least 1 month.
Main Results:
- Anticoagulation showed efficacy in reducing all-cause death (OR 0.64) and cardiovascular events (OR 0.26) compared to control.
- Limited reliable data from older studies and one pilot RCT.
- Observational studies reported contradictory findings.
Conclusions:
- Evidence suggests anticoagulants reduce mortality and cardiovascular events in heart failure patients, but requires cautious interpretation.
- Routine use in heart failure patients with sinus rhythm is not supported by current data.
- A large RCT on warfarin in heart failure patients with sinus rhythm is ongoing.