Study co-author Dr. Douglas L. Mann of Washington University School of Medicine in St. Louis, who treats patients at Barnes-Jewish Hospital, said heart failure is a condition in which the heart can't pump enough blood to the body, increasing the risk of blood clots that can cause a fatal or disabling stroke. Both aspirin and warfarin reduce the risk of stroke, but they do so by different mechanisms and with different risks, Mann said.
"For the first time, clinicians have reassurance that they don't need to put people with heart failure who have a normal rhythm on anti-coagulants like warfarin, which increase the risk of bleeding," Mann said in a statement. "We can give patients aspirin and be reassured that it's not going to either worsen the heart failure or lead to increased risk of death."
The 10-year trial tracked 2,305 patients and compared the anti-coagulant warfarin, or Coumadin, to aspirin. Previous studies have shown warfarin is superior to aspirin for preventing stroke in heart failure patients with atrial fibrillation, a common irregular heart beat.
This trial compared warfarin to aspirin for heart failure patients with a normal heart rhythm.
Patients enrolled in the trial were randomly assigned to receive aspirin and placebo warfarin, or vice versa.
The study, published in the New England Journal of Medicine, found patients taking warfarin had almost half the risk of stroke compared to those taking aspirin, while patients taking warfarin had more than twice the risk of major bleeding. These results cancel each other out and point to the importance of tailoring the treatment to individual patients, the study concluded.