Warfarin doesn't prevent death

Warfarin doesn't prevent death

Warfarin is no more effective than aspirin in preventing mortality in patients with heart failure who are not in atrial fibrillation (AF), according to a new study. More than 2300 patients with a left ventricular ejection fraction less than 35% (average 25%) and a mean age of 61 years were randomized to warfarin with a target INR of 2.0-3.5 or aspirin 325 mg per day. The primary outcome was ischemic stroke, intracerebral hemorrhage, or death from any cause. Patients were followed for up to 6 years with a mean follow-up of 3.5 years. There was no difference in the primary outcome (7.47 events per 100 patient years for warfarin, 7.93 for aspirin; HR with warfarin 0.93, CI, 0.79 to 1.10, P = 0.40). Warfarin was associated with a significant reduction in the rate of ischemic stroke but was associated with a higher rate of hemorrhage. The authors conclude that among patients with heart failure who are in sinus rhythm, there was no difference in outcome between warfarin and aspirin, but note that since warfarin was associated with a lower risk of ischemic stroke, the choice between the two drugs should be individualized (N Engl J Med 2012;366:1859-1869). An accompanying editorial asks, "Could there be some patients with heart failure who would benefit from warfarin?" Those with AF, a history of cardioembolic stroke, history of left ventricular thrombus, and perhaps those with atherothrombotic coronary artery disease may benefit, but in general, warfarin cannot be recommended for patients with heart failure who are not in AF (N Engl J Med 2012;366:1936-1938). n