(RxWiki News) When it comes to helping heart failure patients avoid a stroke, common over-the-counter aspirin may be just as effective as a prescription blood thinner.
A recent large-scale study revealed that aspirin was similar to Coumadin (warfarin) in preventing strokes or reducing deaths among heart failure patients with normal heart rhythms.
"Talk to your doctor about blood thinners for stroke prevention."
Dr. Shunichi Homma, lead author of the study and the Margaret Milliken Hatch Professor of Medicine at Columbia University, said that warfarin has a slight benefit for patients who have been taking it more than four years, but that overall the effectiveness of warfarin and aspirin was similar.
During the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial, researchers followed 2,305 patients with heart failure and normal heart rhythm for up to six years, with an average follow up time of three and a half years.
Participants came from 11 different countries, averaged 61 years old, and had reduced function of the left ventricle, which acts as the heart's main pumping chamber. About 13 percent of patients suffered a stroke or mini-stroke and were considered high risk for a recurrence.
During the double-blind trial, patients were randomly assigned to take either 325 milligrams a day of aspirin or warfarin to thin the blood. Participants received frequent blood testing to monitor the dosing and ensure blood had been thinned to the desired level.
They found that the rate of patient death, ischemic stroke and brain bleeding was 7.47 percent among warfarin patients and 7.93 percent among those who took aspirin. The findings were not considered statistically significant.
Patients taking warfarin who were followed for nearly four years, however, did better as compared to the aspirin group. Over the entire study period, warfarin patients were half as likely to have a stroke as compared to participants who took aspirin. The stroke rate was low for both groups, occurring in 0.72 percent of warfarin patients and 1.36 percent of patients taking aspirin.
Major bleeding occurred in 1.8 percent of warfarin patients and 0.9 percent who took aspirin, which was considered a statistically significant finding. However, Dr. Homma noted that bleeding in the brain -- the one feared most by patients -- rarely occurred in either group. It occurred in 0.12 percent annually in the warfarin group and 0.05 percent a year in the aspirin group.
“Given that there is no overall difference between the two treatments and that possible benefit of warfarin does not start until after four years of treatment, there is no compelling reason to use warfarin, especially considering the bleeding risk,” Dr. Homma said.
Investigators are analyzing the results to determine if certain subgroups of patients may receive more benefit from either treatment.
The study, funded by the National Institutes of Health/National Institute of Neurological Disorders and Stroke, was presented Friday at the American Stroke Association’s International Stroke Conference 2012 in New Orleans.