At present , there are no data on the role of oral anticoagulation versus antiplatelet agents in heart failure with preserved ejection fraction with sinus rhythm .
Also , there were no data from RCTs on the utility of non-vitamin K antagonist oral anticoagulants compared to antiplatelet agents in heart failure with sinus rhythm
BACKGROUND Morbidity in patients with chronic heart failure is high , and this predisposes them to thrombotic complications , including stroke and thromboembolism , which in turn contribute to high mortality .
Oral anticoagulants ( e.g. warfarin ) and antiplatelet agents ( e.g. aspirin ) are the principle oral antithrombotic agents .
Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure .
Oral anticoagulants have become a st and ard in the management of heart failure with atrial fibrillation .
However , a question remains regarding the appropriateness of oral anticoagulants in heart failure with sinus rhythm .
This up date of a review previously published in 2012 aims to address this question .
OBJECTIVES To assess the effects of oral anticoagulant therapy versus antiplatelet agents for all-cause mortality , non-fatal cardiovascular events and risk of major bleeding in adults with heart failure ( either with reduced or preserved ejection fraction ) who are in sinus rhythm .
Persantine-Aspirin Reinfarction Study. Part II. Secondary coronary prevention with persantine and aspirin.
In the Persantine-Aspirin Reinfa rct ion Study , Part II ( PARIS II ) , 3,128 persons who had recovered from myocardial infa rct ion , suffered from 4 weeks to 4 months previously , were r and omized into two groups : dipyridamole ( Persantine ) plus aspirin ( n = 1,563 ) and placebo ( n = 1,565 ) . The average length of follow-up was 23.4 months . Prespecified primary end points were coronary incidence ( definite nonfatal myocardial infa rct ion plus death due to recent or acute cardiac event ) , coronary mortality ( death due to recent or acute cardiac event ) and total mortality , each at 1 year of patient follow-up and at the end of the study . Coronary incidence in the Persantine plus aspirin group was significantly lower than in the placebo group , both at 1 year ( 30 % reduction ) and at the end of the study ( 24 % reduction ) . The statistically significant differences in coronary incidence , at 1 year and at the end of the study , in favor of the combination treatment remained after adjustment for multiple baseline variables and adjustment for multiple testing ( three end points for two time periods ) . Although there were reductions for other end points , these differences were not statistically significant . Coronary mortality was 20 % lower in the Persantine plus aspirin group compared with the placebo group at 1 year , and 6 % lower overall . Total mortality in the treated group compared with the placebo group was 11 % lower at 1 year and 3 % lower overall . The reduced rates of coronary incidence largely reflected lower rates of definite nonfatal myocardial infa rct ion in the Persantine plus aspirin group . Several subgroups were defined a priori and at the end of the study . The beneficial effect of Persantine plus aspirin compared with placebo for coronary incidence tended to be greater for the following groups of patients : those who had a non-Q wave infa rct ; those who were not taking digitalis ; those who were receiving beta-receptor blocking drugs at baseline ; those who were in New York Heart Association functional class I ; those who had had only one myocardial infa rct ion ; or those who were enrolled in the study early , that is within 85 days of the qualifying myocardial infa rct ion
At present , there are no data on the role of oral anticoagulation versus antiplatelet agents in heart failure with preserved ejection fraction with sinus rhythm .
Also , there were no data from RCTs on the utility of non-vitamin K antagonist oral anticoagulants compared to antiplatelet agents in heart failure with sinus rhythm
BACKGROUND Morbidity in patients with chronic heart failure is high , and this predisposes them to thrombotic complications , including stroke and thromboembolism , which in turn contribute to high mortality .
Oral anticoagulants ( e.g. warfarin ) and antiplatelet agents ( e.g. aspirin ) are the principle oral antithrombotic agents .
Many heart failure patients with sinus rhythm take aspirin because coronary artery disease is the leading cause of heart failure .
Oral anticoagulants have become a st and ard in the management of heart failure with atrial fibrillation .
However , a question remains regarding the appropriateness of oral anticoagulants in heart failure with sinus rhythm .
This up date of a review previously published in 2012 aims to address this question .
OBJECTIVES To assess the effects of oral anticoagulant therapy versus antiplatelet agents for all-cause mortality , non-fatal cardiovascular events and risk of major bleeding in adults with heart failure ( either with reduced or preserved ejection fraction ) who are in sinus rhythm .