Aspirin as Effective as Warfarin for Heart Failure: Study

WEDNESDAY, May 2 (HealthDay News) — Aspirin is just as effective
as the blood-thinner warfarin in preventing stroke and death in heart
failure patients with a normal heart rhythm, a landmark study
indicates.

Although the two treatments are equally effective, researchers from
Columbia University in New York City said their findings could prompt more
doctors and patients to choose aspirin because it is much cheaper.

The 10-year study was the largest comparison of aspirin and warfarin
(Coumadin) in the treatment of heart failure patients. In conducting the
comparison, researchers followed more than 2,300 patients in 11 countries
on three continents. Study participants were assigned randomly either to
aspirin or warfarin, and neither the patient nor their doctor knew which
medication each patient was taking.

The investigators found that the combined risk of death, stroke and
cerebral hemorrhage during the study period was 7.47 percent for patients
taking warfarin and 7.93 percent for patients taking aspirin — a
difference that is statistically insignificant.

Although patients taking warfarin had a nearly 50 percent lower risk
for stroke than those taking aspirin, their risk for major bleeding was
twice as high. As a result, the researchers argued that the benefits do
not outweigh the risks. They noted, however, that taking warfarin for four
years or more may be more effective at preventing stroke and death.

“With at least 6 million Americans — and many more around the world —
suffering from heart failure, the results of the … study will have a
large public health impact,” Dr. Walter Koroshetz, deputy director of the
U.S. National Institute of Neurological Disorders and Stroke, said in a
Columbia University news release. “Patients and their physicians now have
critical information to help select the optimum treatment approach. The
key decision will be whether to accept the increased risk of stroke with
aspirin or the increased risk of primarily gastrointestinal hemorrhage
[stomach bleeding] with warfarin.”

Although the study, published in the May 3 issue of the New England
Journal of Medicine
, found aspirin and warfarin to be equally
effective, the researchers noted that aspirin may be a more likely choice
for doctors and patients.

Like warfarin, aspirin reduces the risk of stroke due to a clot or
blockage. Aspirin, however, is cheaper and available over the counter.
Warfarin also requires a strict dosing regimen, including regular blood
tests to monitor patients’ clotting levels.

“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,” principal
investigator, Dr. Shunichi Homma, associate chief of the cardiology
division at New York-Presbyterian/Columbia and a professor of medicine at
Columbia’s College of Physicians and Surgeons in New York City, said in
the news release. “However, given the convenience and low cost of aspirin,
many may go this route.”

More information

The U.S. National Heart, Lung, and Blood Institute has more about treatments for heart failure.

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