Anticoagulation versus placebo for heart failure in sinus rhythm

Area of Science:

• Cardiology
• Pharmacology

Background:

• Patients with chronic heart failure (HF) face risks of thromboembolic events like stroke and pulmonary embolism.
• Coronary ischemic events also worsen HF progression.
• Oral anticoagulation is established for HF patients with atrial fibrillation, but its use in the broader HF population varies.

Purpose of the Study:

• To determine if long-term oral anticoagulation reduces all-cause mortality, cardiovascular deaths, and major thromboembolic events in HF patients.

Main Methods:

• Searched electronic databases (CENTRAL, MEDLINE, EMBASE) and meeting abstracts up to June 2013.
• Included randomized controlled trials (RCTs) comparing oral anticoagulants with placebo in adults with HF (duration ≥ 1 month).
• Included non-randomized studies for side effect assessment; decisions made by duplicate reviewers.

Main Results:

• Two RCTs (WASH 2004, HELAS 2006) and older, less reliable studies were identified.
• No significant differences in myocardial infarction, non-fatal stroke, or death were observed between oral anticoagulation and placebo groups in the RCTs.
• Retrospective and observational studies reported conflicting results.

Conclusions:

• Limited evidence from major RCTs suggests oral anticoagulation does not significantly alter mortality or vascular events in HF patients with sinus rhythm.
• Routine anticoagulation is not supported for HF patients in sinus rhythm.
• Anticoagulation remains indicated for specific HF patient groups, such as those with atrial fibrillation.