Based on the two major r and omised trials ( HELAS 2006 ; WASH 2004 ) , there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm .
Although oral anticoagulation is indicated in certain groups of patients with heart failure ( for example those with atrial fibrillation ) , the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm
BACKGROUND Patients with chronic heart failure ( heart failure ) are at risk of thromboembolic events , including stroke , pulmonary embolism and peripheral arterial embolism , whilst coronary ischaemic events also contribute to the progression of heart failure .
Long-term oral anticoagulation is established in certain patient groups , including patients with heart failure and atrial fibrillation , but there is wide variation in the indications and use of oral anticoagulation in the broader heart failure population .
OBJECTIVES To determine whether long-term oral anticoagulation reduces total deaths , cardiovascular deaths and major thromboembolic events in patients with heart failure .
Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS).
To evaluate the influence of the angiotensin-converting enzyme inhibitor , enalapril ( 2.5 to 40 mg/day ) , on the prognosis of severe congestive heart failure , defined as New York Heart Association functional class IV , a double-blind study was undertaken in which 253 patients were r and omized to receive either placebo  ( n = 126 ) or enalapril ( n = 127 ) in addition to conventional treatment , including  vasodilators . Follow-up averaged 188 days ( range 1 day to 20 months ) . The reduction in crude mortality within 6 months ( primary objective ) was 40 % in the enalapril-treated group ( from 44 to 26 % , p = 0.002 ) and within 1 year 31 % ( p = 0.001 ) . By the end of the study , 68 subjects in the placebo group and 50 in the enalapril group had died -- a reduction of 27 % ( p = 0.003 ) . The entire reduction in total mortality ( 50 % ) was found in patients dying from progressive heart failure , whereas no difference was seen in the incidence of sudden cardiac death . There was a significant improvement in New York Heart Association classification in the enalapril group , together with a reduction in heart size and a reduced requirement for other heart failure medication . It is concluded that the addition of enalapril to conventional therapy in patients with severe congestive heart failure can reduce mortality and improve symptoms . The effect seems to be due to a reduction in death from progression of heart failure
Based on the two major r and omised trials ( HELAS 2006 ; WASH 2004 ) , there is no convincing evidence that oral anticoagulant therapy modifies mortality or vascular events in patients with heart failure and sinus rhythm .
Although oral anticoagulation is indicated in certain groups of patients with heart failure ( for example those with atrial fibrillation ) , the available data does not support the routine use of anticoagulation in heart failure patients who remain in sinus rhythm
BACKGROUND Patients with chronic heart failure ( heart failure ) are at risk of thromboembolic events , including stroke , pulmonary embolism and peripheral arterial embolism , whilst coronary ischaemic events also contribute to the progression of heart failure .
Long-term oral anticoagulation is established in certain patient groups , including patients with heart failure and atrial fibrillation , but there is wide variation in the indications and use of oral anticoagulation in the broader heart failure population .
OBJECTIVES To determine whether long-term oral anticoagulation reduces total deaths , cardiovascular deaths and major thromboembolic events in patients with heart failure .