Antithrombotic treatment in chronic heart failure and sinus rhythm: Systematic review

AIM: To assess the efficacy and safety of antithrombotic drugs (antiplatelet or anticoagulant drugs) compared to no antithrombotic treatment or placebo in patients with heart failure (HF) and sinus rhythm. METHODS: We searched Medline and Cochrane Library for randomized controlled trials evaluating antithrombotic treatment and no antithrombotic treatment in patients with HF and sinus rhythm. Risk ratio (RR) and 95% CIs were estimated performing meta-analysis with random effects method. RESULTS: Two studies met the inclusion criteria: Heart failure Long-term Antithrombotic Study and Warfarin/Aspirin Study in Heart failure, with 336 patients and mean follow-up 1.8-2.25 years. Stroke risk was not reduced by acetylsalicylic acid (RR = 1.18, 95% CI: 0.17-8.15), oral anticoagulation (RR = 0.30, 95% CI: 0.03-2.65) or overall antithrombotic drugs (RR = 0.52, 95% CI: 0.10-2.74). Acetylsalicylic acid showed a significant increased risk of worsening HF (RR = 1.78, 95% CI: 1.08-2.92), while oral anticoagulation had no impact in this outcome (RR = 1.03, 95% CI: 0.61-1.75). Overall antithrombotic drugs showed a significant risk increase of major bleeding (RR = 6.99, 95% CI: 0.89-54.64). CONCLUSION: Best available evidence does not support the routine use of antithrombotic drugs in patients with HF and sinus rhythm. These drugs, particularly oral anti-coagulation has the hazard of increase significantly major bleeding risk.