In the Journals

Aspirin, warfarin confer similar outcomes in HF

The risk for HF events did not differ among patients with HF with reduced ejection fraction who were treated with aspirin or warfarin, according to a post hoc analysis published in JACC: Heart Failure.

“Up to 40% of Americans take aspirin, and in [patients with HF], this number may even be higher,” Susan Graham, MD, a cardiologist and professor of medicine at the University of Buffalo in New York, said in a press release. “It’s a great relief to learn that aspirin is safe for this population. One challenge in cardiology is that we may need to use many drugs, including two or three blood thinners. We always want to be sure we’re helping patients, not creating problems.”

Researchers analyzed data from 489 patients from the WARCEF study with HFrEF who had at least one HF-related event, which included HF death, HF hospitalization or both. Patients were assigned 325 mg per day of aspirin (n = 224) or an acceptable target INR range of 2 to 3.5 of warfarin (n = 265). Most patients (98.6%) were on ACE inhibitor or angiotensin II receptor antagonist treatment.

After adjustment, the time to HF event (adjusted HR = 0.87; 95% CI, 0.72-1.04) and first hospitalization alone (adjusted HR = 0.88; 95% CI, 0.73-1.06) did not differ between both groups.

HF deaths occurred in 6% of patients in the aspirin group and 6.7% of patients in the warfarin group, although there was no significant difference regarding time to HF death.

Conditional and marginal models did not show significant risk differences between both groups for subsequent events or recurrent HF hospitalization.

“WARCEF provides important reassurance that the use of aspirin is not associated with an increase in clinically meaningful exacerbations of HF leading to hospitalization or an increase in death due to HF, when compared to patients who were receiving warfarin,” John R. Teerlink, MD, professor at the University of California, San Francisco School of Medicine and director of the heart failure program and of the clinical echocardiography laboratory at the San Francisco Veterans Affairs Medical Center, and colleagues wrote. – by Darlene Dobkowski

Disclosures: Graham reports no relevant financial disclosures. Teerlink reports receiving support from Actelion, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Celyad, Merck, Novartis, Relypsa, Stealth, St. Jude Medical/Abbott, Trevena and ZS Pharma. Please see the study for all other authors’ relevant financial disclosures.

The risk for HF events did not differ among patients with HF with reduced ejection fraction who were treated with aspirin or warfarin, according to a post hoc analysis published in JACC: Heart Failure.

“Up to 40% of Americans take aspirin, and in [patients with HF], this number may even be higher,” Susan Graham, MD, a cardiologist and professor of medicine at the University of Buffalo in New York, said in a press release. “It’s a great relief to learn that aspirin is safe for this population. One challenge in cardiology is that we may need to use many drugs, including two or three blood thinners. We always want to be sure we’re helping patients, not creating problems.”

Researchers analyzed data from 489 patients from the WARCEF study with HFrEF who had at least one HF-related event, which included HF death, HF hospitalization or both. Patients were assigned 325 mg per day of aspirin (n = 224) or an acceptable target INR range of 2 to 3.5 of warfarin (n = 265). Most patients (98.6%) were on ACE inhibitor or angiotensin II receptor antagonist treatment.

After adjustment, the time to HF event (adjusted HR = 0.87; 95% CI, 0.72-1.04) and first hospitalization alone (adjusted HR = 0.88; 95% CI, 0.73-1.06) did not differ between both groups.

HF deaths occurred in 6% of patients in the aspirin group and 6.7% of patients in the warfarin group, although there was no significant difference regarding time to HF death.

Conditional and marginal models did not show significant risk differences between both groups for subsequent events or recurrent HF hospitalization.

“WARCEF provides important reassurance that the use of aspirin is not associated with an increase in clinically meaningful exacerbations of HF leading to hospitalization or an increase in death due to HF, when compared to patients who were receiving warfarin,” John R. Teerlink, MD, professor at the University of California, San Francisco School of Medicine and director of the heart failure program and of the clinical echocardiography laboratory at the San Francisco Veterans Affairs Medical Center, and colleagues wrote. – by Darlene Dobkowski

Disclosures: Graham reports no relevant financial disclosures. Teerlink reports receiving support from Actelion, Amgen, AstraZeneca, Bayer, Bristol-Myers Squibb, Celyad, Merck, Novartis, Relypsa, Stealth, St. Jude Medical/Abbott, Trevena and ZS Pharma. Please see the study for all other authors’ relevant financial disclosures.