No difference between aspirin and warfarin in heart failure

The results of the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial, which excluded patient with atrial fibrillation, cast doubt on the routine use of warfarin in most patients with heart failure because of the increased risk of bleeding, experts said.

The landmark trial of 2305 patients with severe left ventricular dysfunction in 11 countries who were followed for 10 years, found the combined risk of death, stroke and cerebral haemorrhage was 7.47% a year for patients taking warfarin and 7.93% for those on aspirin, a non-significant difference.

Warfarin patients had half the stroke risk of those on aspirin but double the risk for bleeding, the researchers said.

“Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular needs, lead author Dr Shunichi Homma, of Columbia