Simpler approach to stroke prevention in heart patients

A new study shows that aspirin may be just as effective as the conventional blood thinner warfarin for heart failure patients when it comes to balancing stroke prevention with adverse effects, particularly bleeding. The finding is important because heart failure (HF) is a common and serious problem affecting millions of Americans, especially among the older population. In HF, the heart loses much of its ability to pump blood to the lungs and the body, leading to shortness of breath, fatigue, and swelling. Among the many problems related to HF, clots that move from the heart to the brain can cause a stroke. In order to prevent such a devastating complication of HF, blood thinners such as warfarin (Coumadin) are often prescribed.

According to the new multicenter study published in the New England Journal of Medicine, researchers led by Dr. Shunichi Homma of the Columbia University Medical Center tracked over 2,000 HF patients over the course of 10 years. Ultimately, the results showed no statistically significant difference in the combined endpoints of stroke, cerebral hemorrhage, and death for patients taking aspirin versus those treated with the anticoagulant warfarin. The risk of having any of these complications was 7.47 percent in the warfarin cohort and 7.93 percent in the aspirin cohort. However, not all benefits were equally distributed: Patients taking warfarin had half the stroke risk of those taking aspirin, yet the warfarin patients also had double the risk for major bleeding.

While there was some suggestion that warfarin may provide a greater advantage than aspirin, the difference was not significant. Thus, the investigators concluded that, for now, the overall risks and benefits of warfarin and aspirin are similar. Treatment decisions should be based on a patient s medical history and current needs.

As ACSH s Dr. Gilbert Ross observes, the key factor here will be whether the patient is already at a greater risk of bleeding. If that is the case, he says, now we know that there s a cheap and convenient alternative to treatment with warfarin. In that respect, the data accumulated in this study are tremendously helpful, assuming, of course, that these findings are replicated in a larger study.The finding is important because heart failure (HF) is a common and serious problem affecting millions of Americans, especially among the older population. In HF, the heart loses much of its ability to pump blood to the lungs and the body, leading to shortness of breath, fatigue, and swelling. Among the many problems related to HF, clots that move from the heart to the brain can cause a stroke. In order to prevent such a devastating complication of HF, blood thinners such as warfarin (Coumadin) are often prescribed.

According to the new multicenter study published in the New England Journal of Medicine, researchers led by Dr. Shunichi Homma of the Columbia University Medical Center tracked over 2,000 HF patients over the course of 10 years. Ultimately, the results showed no statistically significant difference in the combined endpoints of stroke, cerebral hemorrhage, and death for patients taking aspirin versus those treated with the anticoagulant warfarin. The risk of having any of these complications was 7.47 percent in the warfarin cohort and 7.93 percent in the aspirin cohort. However, not all benefits were equally distributed: Patients taking warfarin had half the stroke risk of those taking aspirin, yet the warfarin patients also had double the risk for major bleeding.

While there was some suggestion that warfarin may provide a greater advantage than aspirin, the difference was not significant. Thus, the investigators concluded that, for now, the overall risks and benefits of warfarin and aspirin are similar. Treatment decisions should be based on a patient s medical history and current needs.

As ACSH s Dr. Gilbert Ross observes, the key factor here will be whether the patient is already at a greater risk of bleeding. If that is the case, he says, now we know that there s a cheap and convenient alternative to treatment with warfarin. In that respect, the data accumulated in this study are tremendously helpful, assuming, of course, that these findings are replicated in a larger study.