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The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for

J G F Cleland1, I Findlay, S Jafri

  • 1Academic Unit, Department of Cardiology, Castlehill Hospital, University of Hull, Kingston upon Hull, United Kingdom. J.G.Cleland@hull.ac.uk

American Heart Journal
|June 25, 2004
PubMed

Insights

Aspirin did not improve outcomes and increased hospitalizations in heart failure patients. Warfarin benefits remain unproven, indicating antithrombotic therapy in heart failure is not evidence-based.

Area of Science:

  • Cardiology
  • Vascular Medicine
  • Pharmacology

Background:

  • Heart failure frequently co-occurs with vascular disease and athero-thrombotic events.
  • The role of antithrombotic therapy in heart failure management is not well-defined.

Purpose of the Study:

  • To assess the feasibility and inform the design of a larger outcome study on antithrombotic therapy in heart failure.
  • To compare the safety and efficacy of no antithrombotic therapy, aspirin, and warfarin in heart failure patients.

Main Methods:

  • Open-label, randomized, controlled trial involving 279 patients with heart failure and left ventricular systolic dysfunction.
  • Comparison of no antithrombotic therapy, aspirin (300 mg/day), and warfarin (target INR 2.5).
  • Primary outcome: composite of death, nonfatal myocardial infarction, or nonfatal stroke.

Main Results:

  • No significant difference in the primary outcome among the three groups.
  • Aspirin group showed a trend towards worse secondary outcomes.
  • Significantly more hospitalizations for cardiovascular reasons, particularly worsening heart failure, in the aspirin group (P=.044).

Conclusions:

  • The Warfarin/Aspirin Study in Heart failure (WASH) found no evidence supporting aspirin's effectiveness or safety in heart failure.
  • The benefits of warfarin in heart failure patients with sinus rhythm are not established.
  • Current antithrombotic therapy for heart failure lacks evidence and contributes to polypharmacy.
Abstract

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