BACKGROUND: Heart failure is commonly associated with vascular disease and a high rate of athero-thrombotic events, but the risks and benefits of antithrombotic therapy are unknown. METHODS: The current study was an open-label, randomized, controlled trial comparing no antithrombotic therapy, aspirin (300 mg/day), and warfarin (target international normalized ratio 2.5) in patients with heart failure and left ventricular systolic dysfunction requiring diuretic therapy. The primary objective was to demonstrate the feasibility and inform the design of a larger outcome study. The primary clinical outcome was death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS:Two hundred seventy-nine patients were randomized and 627 patient-years exposure were accumulated over a mean follow-up time of 27 +/- 1 months. Twenty-six (26%), 29 (32%), and 23 (26%) patients randomized to no antithrombotic treatment, aspirin, and warfarin, respectively, reached the primary outcome (ns). There were trends to a worse outcome among those randomized to aspirin for a number of secondary outcomes. Significantly (P =.044) more patients randomized to aspirin were hospitalized for cardiovascular reasons, especially worsening heart failure. CONCLUSIONS: The Warfarin/Aspirin Study in Heart failure (WASH) provides no evidence that aspirin is effective or safe in patients with heart failure. The benefits of warfarin for patients with heart failure in sinus rhythm have not been established. Antithrombotic therapy in patients with heart failure is not evidence based but commonly contributes to polypharmacy.
RCT Entities:
BACKGROUND:Heart failure is commonly associated with vascular disease and a high rate of athero-thrombotic events, but the risks and benefits of antithrombotic therapy are unknown. METHODS: The current study was an open-label, randomized, controlled trial comparing no antithrombotic therapy, aspirin (300 mg/day), and warfarin (target international normalized ratio 2.5) in patients with heart failure and left ventricular systolic dysfunction requiring diuretic therapy. The primary objective was to demonstrate the feasibility and inform the design of a larger outcome study. The primary clinical outcome was death, nonfatal myocardial infarction, or nonfatal stroke. RESULTS: Two hundred seventy-nine patients were randomized and 627 patient-years exposure were accumulated over a mean follow-up time of 27 +/- 1 months. Twenty-six (26%), 29 (32%), and 23 (26%) patients randomized to no antithrombotic treatment, aspirin, and warfarin, respectively, reached the primary outcome (ns). There were trends to a worse outcome among those randomized to aspirin for a number of secondary outcomes. Significantly (P =.044) more patients randomized to aspirin were hospitalized for cardiovascular reasons, especially worsening heart failure. CONCLUSIONS: The Warfarin/Aspirin Study in Heart failure (WASH) provides no evidence that aspirin is effective or safe in patients with heart failure. The benefits of warfarin for patients with heart failure in sinus rhythm have not been established. Antithrombotic therapy in patients with heart failure is not evidence based but commonly contributes to polypharmacy.
Authors: John R Teerlink; Min Qian; Natalie A Bello; Ronald S Freudenberger; Bruce Levin; Marco R Di Tullio; Susan Graham; Douglas L Mann; Ralph L Sacco; J P Mohr; Gregory Y H Lip; Arthur J Labovitz; Seitetz C Lee; Piotr Ponikowski; Dirk J Lok; Stefan D Anker; John L P Thompson; Shunichi Homma Journal: JACC Heart Fail Date: 2017-08 Impact factor: 12.035
Authors: Marjan Mujib; Abu-Ahmed Z Rahman; Ravi V Desai; Mustafa I Ahmed; Margaret A Feller; Inmaculada Aban; Thomas E Love; Michel White; Prakash Deedwania; Wilbert S Aronow; Gregg Fonarow; Ali Ahmed Journal: Am J Cardiol Date: 2010-12-22 Impact factor: 2.778
Authors: Christos V Bourantas; Huan P Loh; Nasser Sherwi; Ann C Tweddel; Ramesh de Silva; Elena I Lukaschuk; Antony Nicholson; Alan S Rigby; Simon D Thackray; Duncan F Ettles; Nikolay P Nikitin; Andrew L Clark; John G F Cleland Journal: Heart Fail Rev Date: 2012-03 Impact factor: 4.214
Authors: Per Olav Vandvik; A Michael Lincoff; Joel M Gore; David D Gutterman; Frank A Sonnenberg; Pablo Alonso-Coello; Elie A Akl; Maarten G Lansberg; Gordon H Guyatt; Frederick A Spencer Journal: Chest Date: 2012-02 Impact factor: 9.410