title: Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
abstract: BACKGROUND
  Heart failure (HF) patients show high morbidity and mortality rate with increased risk of malignant arrhythmia and thromboembolism. Anticoagulation reduces embolic event and death rates in HF patients with atrial fibrillation, but if antithrombotic therapy is beneficial in patients with HF in sinus rhythm is still debated.
  
  
  RESULTS
  We conducted a systematic review of prospective, randomized controlled trials (RCTs) to assess the efficacy and safety of oral anticoagulant therapies (OATs) compared to antiplatelet treatment in HF patients in sinus rhythm. MEDLINE, Web of Science, CENTRAL and Scopus databases were searched up to May 2012. Four RCTs were identified and a total of 3663 patients were included in the meta-analysis. Patients with both ischemic and non-ischemic HF were included. There was no significant difference in mortality (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.86 to 1.19) between OATs group and antiplatelet drug group. OATs have reduced ischemic stroke risk (OR 0.49, 95% CI 0.32 to 0.74), but have increased major bleeding risk (OR 2.01, 95% CI 1.40 to 2.88) compared to antiplatelet treatment.
  
  
  CONCLUSIONS
  In HF patients in sinus rhythm OATs do not show a better risk-benefit profile compared to antiplatelet treatment in cardioembolism prevention. Warfarin and aspirin seem to be similar in reducing mortality. Warfarin reduces the incidence of ischemic stroke, but increases major bleedings. Thus, it is possible to speculate that aspirin prescription be indicated in patients with high risk of bleeding, whereas warfarin could be preferred in patients with high thromboembolic risk.
authors.affiliation: Division of Cardiology, Salvatore Maugeri Foundation, IRCCS - Scientific Institute of Telese Terme, Benevento, Italy. giuseppe.rengo@unina.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.forename: Gennaro
authors.initials: G
authors.lastname: Pagano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Squizzato
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Moja
authors.forename: Grazia Daniela
authors.initials: GD
authors.lastname: Femminella
authors.forename: Claudio
authors.initials: C
authors.lastname: de Lucia
authors.forename: Klara
authors.initials: K
authors.lastname: Komici
authors.forename: Valentina
authors.initials: V
authors.lastname: Parisi
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Nicola
authors.initials: N
authors.lastname: Ferrara
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
authors.forename: Dario
authors.initials: D
authors.lastname: Leosco
mesh_terms: D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage*; D001145:Arrhythmias, Cardiac / Q000517:prevention & control; D001241:Aspirin / Q000627:therapeutic use; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin