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 .
The effect of low-dose warfarin on the risk of stroke in patients with nonrheumatic atrial fibrillation.
BACKGROUND Nonrheumatic atrial fibrillation increases the risk of stroke , presumably from atrial thromboemboli . There is uncertainty about the efficacy and risks of long-term warfarin therapy to prevent stroke . METHODS We conducted an unblinded , r and omized , controlled trial of long-term , low-dose warfarin therapy ( target prothrombin-time ratio , 1.2 to 1.5 ) in patients with nonrheumatic atrial fibrillation . The control group was not given warfarin but could choose to take aspirin . RESULTS A total of 420 patients entered the trial ( 212 in the warfarin group and 208 in the control group ) and were followed for an average of 2.2 years .  Prothrombin times in the warfarin group were in the target range 83 percent of the time . Only 10 percent of the patients assigned to receive warfarin discontinued the drug permanently . There were 2 strokes in the warfarin group ( incidence , 0.41 percent per year ) as compared with 13 strokes in the control group ( incidence , 2.98 percent per year ) , for a reduction of 86 percent in the risk of stroke ( warfarin : control incidence ratio = 0.14 ; 95 percent confidence interval , 0.04 to 0.49 ; P = 0.0022 ) . There were 37 deaths altogether . The death rate was markedly lower in the warfarin group than in the control group : 2.25 percent as compared with 5.97 percent per year , for an incidence ratio of 0.38 ( 95 percent confidence interval , 0.17 to 0.82 ; P = 0.005 ) . There was one fatal hemorrhage in each group . The frequency of bleeding events that led to hospitalization or transfusion was essentially the same in both groups . The warfarin group had a higher rate of minor hemorrhage than the control group ( 38 vs. 21 patients ) . CONCLUSIONS Long-term low-dose warfarin therapy is highly effective in preventing stroke in patients with non-rheumatic atrial fibrillation , and can be quite safe with careful monitoring
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 .