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Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis

Giuseppe Rengo1, Gennaro Pagano, Alessandro Squizzato

  • 1Division of Cardiology, Salvatore Maugeri Foundation, IRCCS - Scientific Institute of Telese Terme, Benevento, Italy. giuseppe.rengo@unina.it

Plos One
|January 10, 2013
PubMed

Insights

Oral anticoagulant therapies (OATs) do not improve outcomes for heart failure (HF) patients in sinus rhythm compared to antiplatelet drugs. While OATs reduce stroke risk, they increase major bleeding events, suggesting tailored treatment based on individual patient risk factors.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Medicine

Background:

  • Heart failure (HF) is associated with high rates of morbidity, mortality, malignant arrhythmia, and thromboembolism.
  • Anticoagulation is established for HF patients with atrial fibrillation but its role in HF patients with sinus rhythm remains debated.
  • Understanding antithrombotic therapy benefits in HF patients with sinus rhythm is crucial for optimizing patient care.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) comparing oral anticoagulant therapies (OATs) with antiplatelet treatment in HF patients with sinus rhythm.
  • To assess the efficacy and safety of OATs versus antiplatelet therapy in preventing cardioembolic events and mortality.
  • To evaluate the risk-benefit profile of OATs in this patient population.

Main Methods:

  • Systematic review and meta-analysis of prospective, randomized controlled trials (RCTs).
  • Searched MEDLINE, Web of Science, CENTRAL, and Scopus databases up to May 2012.
  • Included 4 RCTs with a total of 3663 patients (ischemic and non-ischemic HF) in sinus rhythm.

Main Results:

  • No significant difference in mortality was observed between OATs and antiplatelet treatment (OR 1.01, 95% CI 0.86-1.19).
  • OATs significantly reduced the risk of ischemic stroke (OR 0.49, 95% CI 0.32-0.74).
  • OATs significantly increased the risk of major bleeding events (OR 2.01, 95% CI 1.40-2.88) compared to antiplatelet therapy.

Conclusions:

  • Oral anticoagulant therapies (OATs) do not offer a superior risk-benefit profile compared to antiplatelet treatment for cardioembolism prevention in HF patients with sinus rhythm.
  • Warfarin and aspirin demonstrated similar efficacy in reducing mortality.
  • Warfarin is more effective in preventing ischemic stroke but carries a higher risk of major bleeding; aspirin may be preferred for patients with high bleeding risk, while warfarin suits those with high thromboembolic risk.
Abstract

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