International Stroke Conference 2012: Anticlotting agents offer similar prevention rates of stroke, death in heart failure patients with normal heart rhythm

Warfarin is similar to aspirin in preventing deaths and strokes in patients with heart failure and normal heart rhythm, according to the largest and longest head-to-head comparison study of the 2 anticlotting drugs. The results of the late-breaking research were presented at the International Stroke Conference 2012 in New Orleans.

"Although there was a warfarin benefit for patients treated for 4 or more years, overall warfarin and aspirin were similar," said Shunichi Homma, MD, lead author of the study and the Margaret Milliken Hatch professor of medicine at Columbia University, NY.

"Given that there is no overall difference between the 2 treatments and that possible benefit of warfarin does not start until after 4 years of treatment, there is no compelling reason to use warfarin, especially considering the bleeding risk," Dr Homma added.

Researchers randomly assigned patients to receive either 325 mg/day of aspirin or warfarin doses, calibrated to a pre-specified level of blood thinning. They found that death, ischemic stroke, or intracerebral hemorrhage, occurred at a rate of 7.47% for the warfarin patients and 7.93% for patients assigned to aspirin, which is not a "statically significant" difference, the researchers wrote.

However, in the group of patients followed for more than 3 years, those on warfarin did better, according to Dr Homma. Over the entire study period, patients receiving warfarin were just over half as likely to develop a stroke as those taking aspirin.

Conversely, major bleeds occurred in 1.8% of warfarin patients versus 0.9% of aspirin patients, during each year of the study, according to the researchers. "As expected, the overall bleeding rate was higher with warfarin. However, not all bleeds are equal, and the one that patients fear the most-bleeding within the brain [intracerebral hemorrhage]-occurred rarely in both groups," Dr Homma said. Intracerebral hemorrhage occurred in .12% per year in the warfarin patient group and .05% per year in the aspirin group.