Aspirin is 'as effective as warfarin' for most heart failure patients
Warfarin users had half the
risk of having a stroke than those on aspirin, but had twice the risk of major bleeding



09:17 GMT, 3 May 2012

Aspirin could be just as good as more expensive drugs for patients with heart failure, say researchers.

In the largest trial of its, the popular painkiller was found to be as effective as warfarin for preventing a combined risk of death, stroke, and cerebral hemorrhage in heart failure patients.

For while warfarin users had half the risk of having a stroke than those on aspirin, they had twice the risk for major bleeding.

Which to take A study found aspirin and warfarin were effective in different ways

Which to take A study found aspirin and warfarin were effective in different ways

Heart failure affects 900,000 people in the UK and six million in the U.S. The condition is when the heart has trouble enough blood around the body and usually occurs when the heart muscle becomes too weak or stiff to work properly. Sufferers can experience breathlessness, tiredness and swollen legs.

The double-blind 10-year study by Columbia University Medical Center followed more than 2,000 patients in 11 countries.

Research leader Dr Shunichi Homma, 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 medical

'However, given the convenience and low cost of aspirin, many may
go this route.'


Besides acting as a painkiller aspirin acts as an anti-inflammatory

The pill thins the blood and a low daily dose of 75mg has been found to reduce the risk of clots forming in the blood.

Research suggests the benefits of taking a daily aspirin outweigh the small risk of side-effects in patients with heart disease, although a doctor should always be consulted.

A series of studies involving 200,000 patients found the pill also cut the risk of dying of cancer by 37 per cent if taken for five years.

However, haemophiliacs and those with ulcers should not take it. Nor should children under 16 as it has been linked to an often fatal condition called Reye's syndrome.

For patients with heart failure, a
weakened heart means a greater risk for blood clots that can lead to a
stroke, which can be fatal or disabling.

Aspirin prevents clotting and
warfarin thins the blood, thus reducing the risk of stroke due to a clot
or blockage in a cerebral artery. Unlike aspirin, warfarin requires a
prescription and regular blood work to monitor clotting levels and
adjust drug dosages.

However, Dr Andrew Clark from the British Society for Heart Failure said he would continue prescribing warfarin over aspirin as a stroke was more costly to a patient than bleeding.

'I would regard a gastrointestinal haemorrhage requiring transfusion as being of less importance than a stroke, so would tend in favour of warfarin,' he told the BBC.

In the trial, 2,305 patients with normal heart rhythm were instructed
to take pills from
two bottles, labeled aspirin and warfarin; one was an active medication
while the other was a placebo. All patients took regular blood tests.

In the head-to-head comparison, the
combined risk of death, stroke, and cerebral hemorrhage was 7.47 per cent per
year for patients taking the blood-thinner warfarin, also known by its
brand name Coumadin, and 7.93 per cent per year for those taking aspirin – a
difference that is not statistically significant.

Warfarin tablets are prescribed to thin the blood

Warfarin tablets are prescribed to thin the blood

Patients taking warfarin had a stroke risk of 0.72 per cent per year compared to 1.36 per cent for aspirin. Warfarin patients also had a 1.8 per cent risk of major bleeding compared to 0.87 per cent for aspirin.

In patients followed four years or longer, there was evidence that warfarin may be more effective in preventing the combined outcome of death, stroke, and intracerebral hemorrhage. The researchers said further investigation would be needed.

Previous studies established warfarin to be superior to aspirin for preventing stroke in heart failure patients with atrial fibrillation.

The study findings have been published in the New England Journal of Medicine.