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 .
Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group.
BACKGROUND Milrinone , a phosphodiesterase inhibitor , enhances cardiac contractility by increasing intracellular levels of cyclic AMP , but the long-term effect of this type of positive inotropic agent on the survival of patients with chronic heart failure has not been determined . METHODS We r and omly assigned 1,088 patients with severe chronic heart failure ( New York Heart Association class III or IV ) and advanced left ventricular dysfunction to double-blind treatment with  ( 40 mg of oral milrinone daily ( 561 patients ) or placebo ( 527 patients ) . In addition , all patients received conventional therapy with digoxin , diuretics , and a converting-enzyme inhibitor throughout the trial . The median period of follow-up was 6.1 months ( range , 1 day to 20 months ) . RESULTS As compared with placebo , milrinone therapy was associated with a 28 percent increase in mortality from all causes ( 95 percent confidence interval , 1 to 61 percent ; P = 0.038 ) and a 34 percent increase in cardiovascular mortality ( 95 percent confidence interval , 6 to 69 percent ; P = 0.016 ) . The adverse effect of milrinone was greatest in patients with the most severe symptoms ( New York Heart Association class IV ) , who had a 53 percent increase in mortality ( 95 percent confidence interval , 13 to 107 percent ; P = 0.006 ) . Milrinone did not have a beneficial effect on the survival of any subgroup . Patients treated with milrinone had more hospitalizations ( 44 vs. 39 percent , P = 0.041 ) , were withdrawn from double-blind therapy more frequently ( 12.7 vs. 8.7 percent , P = 0.041 ) , and had serious adverse cardiovascular reactions , including hypotension ( P = 0.006 ) and syncope ( P = 0.002 ) , more often than the patients given placebo . CONCLUSIONS Our findings indicate that despite its beneficial hemodynamic actions , long-term therapy with oral milrinone increases the morbidity and mortality of patients with severe chronic heart failure . The mechanism by which the drug exerts its deleterious effects is unknown
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 .