Abstract 392: Warfarin Versus Aspirin in Patients with Systolic Heart Failure and Normal Sinus Rhythm: Insights From a Meta-Analysis

Background: It is unknown whether warfarin or aspirin therapy is superior for the treatment of patients with systolic heart failure who are in sinus rhythm. Methods: We performed a systematic literature search for randomized trials comparing warfarin and aspirin in patients with systolic heart failure which provided the event rates for ischemic stroke, major hemorrhage and death in the two groups. Heterogeneity of the studies was analyzed by Q statistics. The studies were homogeneous for each outcome; therefore the fixed-effect model was used to compute the relative risk based on the number of events and total number of patients in each group. A two-sided alpha error of <0.05 was considered to be statistically significant (p<0.05). Results: We found 4 randomized clinical trials comparing warfarin and aspirin therapy in patients with systolic heart failure with a mean duration of follow up of 2.3 years enrolling a total of 3663 patients. The relative risk for ischemic stroke in patients treated with warfarin was 0.50 with 95% confidence interval (CI) of 0.33 - 0.75 (P= 0.001) while the relative risk for major hemorrhage was 1.94 with 95% CI of 1.40- 2.71 (P= 0.000) in comparison to the aspirin group. The relative risk of death was 1.01 with 95% CI of 0.89- 1.14 (P= 0.871) in the warfarin group compared to the aspirin group. Conclusion: Although warfarin therapy appears to reduce the risk of ischemic stroke in patients with systolic heart failure who are in sinus rhythm, the reduction comes at the cost of higher risk of bleeding and there is no evidence of an overall benefit on mortality. ![][1] [1]: /embed/graphic-1.gif