title: Efficacy and safety of warfarin vs. antiplatelet therapy in patients with systolic heart failure and sinus rhythm: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Heart failure is an independent risk factor for stroke. Anticoagulation is effective for prevention of cardio-embolic stroke secondary to atrial fibrillation or mechanical heart valves but is of uncertain benefit in heart failure patients. We performed this meta-analysis to obtain the best estimates of the efficacy and safety of warfarin as compared with antiplatelet therapy in patients with systolic heart failure who are in sinus rhythm.
  
  
  RESULTS
  A systematic search was performed using PubMed and Central Register of Controlled Trials databases for all randomized controlled trials, which compare warfarin with antiplatelet therapy given for at least one-month in heart failure patients with sinus rhythm and report at least one of the following outcomes: ischemic stroke, death, myocardial infarction, hospitalization due to worsening heart failure, intracranial hemorrhage, and major hemorrhage. Four randomized controlled trials involving adjusted-dose warfarin (4187 subjects) were included. When compared with antiplatelet therapy, warfarin reduced ischemic stroke by 0·74% per year (RR 0·49; 95% CI: 0·32-0·73: P = 0·0006; Number needed to treat = 135) but increased major hemorrhage by 0·99% per year (RR 2·15; 95% CI: 1·55-2·99: P < 0·00001; Number needed to harm = 101). Warfarin did not significantly affect the risk of death, myocardial infarction, hospitalization due to heart failure or intracranial hemorrhage as compared with antiplatelet therapy.
  
  
  CONCLUSIONS
  Warfarin as compared with antiplatelet therapy reduces risk of ischemic stroke, does not significantly affect death, myocardial infarction, hospitalization due to heart failure or intracranial hemorrhage and increases major hemorrhage in heart failure patients who are in sinus rhythm.
authors.affiliation: Department of Medicine, McMaster University, East Hamilton, ON, Canada.
authors.forename: Aaron Yl
authors.initials: AY
authors.lastname: Liew
authors.forename: John W
authors.initials: JW
authors.lastname: Eikelboom
authors.forename: Stuart J
authors.initials: SJ
authors.lastname: Connolly
authors.forename: Martin
authors.initials: M
authors.lastname: O' Donnell
authors.forename: Robert G
authors.initials: RG
authors.lastname: Hart
mesh_terms: D000925:Anticoagulants / Q000494:pharmacology / Q000627:therapeutic use*; D054143:Heart Failure, Systolic / Q000188:drug therapy*; D006339:Heart Rate / Q000187:drug effects*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D014859:Warfarin / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin
keywords: antiplatelet therapy; heart failure; ischemic stroke; meta-analysis; sinus rhythm; warfarin