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 antithrombotic therapy on risk of sudden coronary death in patients with congestive heart failure.
Data from epidemiologic , autopsy , Holter monitoring , and electrophysiologic studies support the hypothesis that acute myocardial ischemia , even in the absence of myocardial infa rct ion , is a critical component of the pathophysiology of sudden coronary death . Acute myocardial ischemia superimposed upon ventricles damaged from previous infa rct ions has been demonstrated to enhance the generation of lethal ventricular arrhythmias . This is a retrospective analysis of 6,797 participants in the Studies of Left Ventricular Dysfunction prevention and treatment trials . Both univariate and multivariate Cox proportional-hazards modeling were used to study the association of anticoagulant and antiplatelet therapy with the risk for sudden cardiac death . The following covariates were adjusted for in the analysis : age , ejection fraction , gender , atrial fibrillation , diabetes , a history of angina , prior infa rct ion , prior revascularization , and the regular use of beta blockers , diuretics , digoxin , antiarrhythmic agents , or enalapril . The overall incidence of sudden cardiac death per 100 patient-years of follow-up was 2.24 % . In multivariate analysis , antiplatelet and anticoagulant monotherapy each remained independently associated with a reduction in the risk of sudden cardiac death :  antiplatelet therapy with a 24 % reduction ( relative risk [ RR ] 0.76 ; 95 % confidence interval [ CI ] 0.61 - 0.95 ) and antiplatelet monotherapy with a 32 % reduction ( RR 0.68 ; 95 % CI 0.48 - 0.96 ) . Thus , in patients with moderate to severe left ventricular systolic dysfunction result ing from coronary artery disease , antiplatelet and anticoagulant therapy are each associated with a reduction in the risk of sudden cardiac death
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 .