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Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and
Barry M Massie1, Joseph F Collins, Susan E Ammon
1Department of Veterans Affairs, San Francisco, CA, USA.
Circulation
|March 18, 2009
Summary
Warfarin and clopidogrel were not superior to aspirin for preventing major adverse events in heart failure patients. Warfarin showed a trend toward fewer hospitalizations for worsening heart failure compared to aspirin.
Area of Science:
- Cardiology
- Pharmacology
- Internal Medicine
Background:
- Chronic heart failure (CHF) is a significant cause of mortality and morbidity.
- The optimal antithrombotic strategy for CHF patients with reduced ejection fraction (HFrEF) in sinus rhythm remains debated.
- This study addresses the need for evidence-based antithrombotic selection in this population.
Purpose of the Study:
- To determine the optimal antithrombotic agent for patients with symptomatic heart failure and reduced ejection fraction in sinus rhythm.
- To compare the efficacy and safety of warfarin, aspirin, and clopidogrel in this patient group.
Main Methods:
- A prospective, randomized clinical trial involving 1587 patients with HFrEF in sinus rhythm.
- Patients received open-label warfarin (INR 2.5-3.0) or double-blind aspirin (162 mg/day) or clopidogrel (75 mg/day) for at least 12 months.
- The primary outcome was time to first occurrence of death, nonfatal myocardial infarction, or nonfatal stroke.
Main Results:
- No significant difference was found in the primary composite endpoint between warfarin, aspirin, and clopidogrel.
- Warfarin was associated with fewer nonfatal strokes compared to aspirin and clopidogrel.
- Hospitalizations for worsening heart failure were less frequent with warfarin compared to aspirin (P=0.02).
Conclusions:
- The study does not support the hypothesis that warfarin is superior to aspirin or that clopidogrel is superior to aspirin for the primary composite outcome.
- Warfarin may offer benefits in reducing stroke and hospitalizations for heart failure exacerbations in select patients.
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