Aspirin is as 'good as warfarin' for most heart failure patients
Aspirin could be as effective as more expensive drugs for most patients
with heart failure, according to an international team of researchers.
Expensive drugs for most patients with heart failure, according to an international team of researchers.
Their study on more than 2,000 patients, published in the New
England Journal of Medicine, said aspirin was as effective as the
commonly prescribed drug warfarin.
It said each drug had risks, but they had similar benefits overall.
However, a UK cardiologist argued the risks from warfarin were less serious.
Heart failure is a major health problem in many parts of the
world. It affects 900,000 people in the UK and six million people in the
US. A failing heart struggles to pump blood around the body, meaning
even trivial tasks become exhausting.
As the blood is not pumped round the body as efficiently the
risk of a blood clot increases, if a clot blocks blood to parts of the
brain it will result in a stroke.
Aspirin vs warfarin
Patients are treated with drugs to reduce the risk of a fatal
blood clot forming. However, researchers said it was unknown whether
aspirin or warfarin was the better treatment in the 75% of heart failure
patients who still have a normal heart beat.
Researchers gave 2,305 patients, in 11 countries, either aspirin or warfarin.
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Dr Andrew Clark British Society for Heart FailureWarfarin quite markedly reduces the risk of stroke associated with heart failure compared with aspirin, but at a cost of an increase in major haemorrhage”
The combined risk of death, stroke and major bleeding was the same for each drug, according to the researchers.
Patients taking warfarin had a much lower risk of stroke, but
had a high risk of bleeds. They said that after four years there was a
"small benefit" with warfarin, but it was "borderline" and of "uncertain
clinical significance".
They concluded: "There is no compelling reason to use warfarin rather than aspirin".
The lead researcher, Dr Shunichi Homma, from the Columbia
University Medical Center, said: "Since the overall risks and benefits
are similar for aspirin and warfarin, the patient and his or her doctor
are free to choose the treatment that best meets their particular
medical needs.
"However, given the convenience and low cost of aspirin, many may go this route."
Balancing risks
However, Dr Andrew Clark, from the British Society for Heart
Failure and the University of Hull, told the BBC: "The study shown here
demonstrates that warfarin quite markedly reduces the risk of stroke
associated with heart failure compared with aspirin, but at a cost of an
increase in major haemorrhage.
"How to interpret that for individual patients means weighing
the risk of stroke against the risk of haemorrhage, but also weighting
that by importance.
"I would regard a gastrointestinal haemorrhage requiring
transfusion as being of less importance than a stroke, so would tend in
favour of warfarin.
"I would be more inclined to prescribe warfarin that previously, but the evidence is not overwhelming."
The British Heart Foundation said both warfarin and aspirin
had risks and benefits, but this study showed "neither has an advantage
over the other overall in preventing stroke or death in the long term."
Ellen Mason, a senior cardiac nurse at the charity, said:
"This finding should give patients reassurance when discussing their
medication with their heart failure specialist, and more freedom to
choose the treatment which works best for them."
Dr Walter Koroshetz, who is the deputy director of the US
National Institute for Neurological Disorders and Stroke, said the study
would have "a large public health impact".
He added: "Patients and their physicians now have critical information to help select the optimum treatment.
"The key decision will be whether to accept the increased
risk of stroke with aspirin, or the increased risk of primarily
gastrointestinal haemorrhage with warfarin."
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