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

doi:10.13105/wjma.v3.i1.36

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World Journal of Meta-Analysis

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Meta-Analysis

World J Meta-Anal. Feb 26, 2015; 3(1): 36-42
Published online Feb 26, 2015. doi: 10.13105/wjma.v3.i1.36

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

Daniel Caldeira, Inês Cruz, Rita Calé, Cristina Martins, Helder Pereira, Joaquim J Ferreira, Fausto J Pinto, João Costa

Daniel Caldeira, Inês Cruz, Rita Calé, Cristina Martins, Helder Pereira, Cardiology Department, Hospital Garcia de Orta, 2805-267 Almada, Portugal

Daniel Caldeira, Joaquim J Ferreira, João Costa, Clinical Pharmacology Unit, Instituto de Medicina Molecular, 1649-028 Lisbon, Portugal

Daniel Caldeira, Joaquim J Ferreira, João Costa, Laboratory of Clinical Pharmacology, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal

Fausto J Pinto, Cardiology Department, CCUL, CAML, Faculty of Medicine, 1649-028 Lisbon, Portugal

João Costa, Evidence Based Medicine Centre, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal

João Costa, Portuguese Collaborating Centre of the Cochrane Iberoamerican Network, Faculty of Medicine, University of Lisbon, 1649-028 Lisbon, Portugal

Author contributions: Caldeira D and Costa J contributed to the concept and design of the study and acquisition, analysis and interpretation of the data, wrote the first draft of the manuscript, critically revised the manuscript, and gave final approval of the submitted manuscript; Ferreira JJ and Pinto FJ contributed to the concept and design of the study and interpretation of the data, critically revised the manuscript, and gave final approval of the submitted manuscript; Cruz I, Calé R, Martins C and Pereira H contributed to interpretation of data, critically revised the manuscript, and gave final approval of the submitted manuscript.

Correspondence to: Dr. Daniel Caldeira, Laboratory of Clinical Pharmacology, Faculty of Medicine, University of Lisbon, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal. dgcaldeira@hotmail.com

Telephone: +351-21-7973453 Fax: +351-21-7819688

Received: May 20, 2014
Peer-review started: May 23, 2014
First decision: July 10, 2014
Revised: October 30, 2014
Accepted: November 17, 2014
Article in press: November 19, 2014
Published online: February 26, 2015
Processing time: 245 Days and 2.4 Hours

Abstract

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 anticoagulation has the hazard of increase significantly major bleeding risk.

Keywords: Heart failure; Sinus rhythm; Platelet aggregation inhibitors; Anticoagulants

Core tip: In patients with atrial fibrillation, chronic heart failure (CHF) increases thromboembolic risk and oral anticoagulation is essential to decrease the risk of thromboembolic complications. Evidence suggests a positive association between CHF, impaired hemostasis and thromboembolic events. Whether antithrombotic drugs should be recommended for these patients (in sinus rhythm) is still debated. We looked for the best available evidence and we found 2 studies fulfilling the inclusion criteria. We performed a meta-analysis of antithrombotic drugs vs placebo and strengthened that antithrombotic drugs do not decrease the risk of stroke (fatal or non-fatal) and increase the risk of major bleeding.