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Published on: February 28, 2012
Anticoagulation versus placebo for heart failure in sinus rhythm
Gregory Yh Lip1, Benjamin J Wrigley, Ron Pisters
1University of Birmingham Centre for Cardiovascular Sciences, City Hospital, Birmingham, UK. g.y.h.lip@bham.ac.uk.
The Cochrane Database of Systematic Reviews
|June 15, 2012
Summary
Long-term oral anticoagulation does not appear to reduce deaths or major vascular events in heart failure patients with sinus rhythm. Routine use is not supported, pending further research.
Area of Science:
- Cardiology
- Pharmacology
Background:
- Heart failure patients face risks of thromboembolic and coronary ischemic events.
- Oral anticoagulation is standard for heart failure with atrial fibrillation, but its use varies in other heart failure populations.
Purpose of the Study:
- To evaluate if long-term oral anticoagulation decreases mortality and major thromboembolic events in heart failure patients.
Main Methods:
- Systematic review of randomized controlled trials (RCTs) and non-randomized studies up to February 2010.
- Included RCTs comparing oral anticoagulants to placebo in adults with heart failure for at least one month.
- Data extraction and analysis focused on relative measures of effect and confidence intervals.
Main Results:
- Two RCTs (HELAS 2006, WASH 2004) showed no significant difference in myocardial infarction, stroke, or death between oral anticoagulation and placebo groups.
- Older studies and non-randomized analyses yielded unreliable or contradictory results.
- No significant reduction in mortality or vascular events observed with oral anticoagulation in heart failure patients in sinus rhythm.
Conclusions:
- Current evidence from major RCTs does not support routine oral anticoagulation for heart failure patients in sinus rhythm.
- Oral anticoagulation remains indicated for specific heart failure groups, such as those with atrial fibrillation.
- A large ongoing RCT will provide further data on warfarin use in heart failure patients with sinus rhythm.
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