Aspirin could be as effective as more expensive drugs for heartfailure
patients with a normal heart rhythm, according to researchers.
Their study on more than 2,000 patients, published in the New England
Journalof 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 pumpedround 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.
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"
Dr Andrew Clark
British Society for Heart Failure
The combined risk of death, stroke and major bleeding was the same for
each drug, according to theresearchers.
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 than 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 heartfailure 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."
