| Authors |
| Cleland JGF, Findlay I, Jafri S, et al. |
| Title |
| The Warfarin/Aspirin Study in Heart Failure (WASH): A randomized trial comparing antithrombotic strategies for patients with heart failure. |
| References |
| Am Heart J 2004;148:157-164. |
| Background |
| Patients with heart failure have a higher risk of cardiac events, but it is unclear whether antithrombotic therapy is beneficial. |
| Purpose |
| To compare the effect of warfarin, aspirin or no anti-thrombotic therapy in patients with heart failure with systolic dysfunction. |
| Design |
- Prospective, randomised, open-label blinded endpoint (PROBE) pilot study
- 279 patients heart failure (EF<35% or echo evidence) and requiring diuretic. All patients were in normal sinus rhythm.
|
| Exclusion Criteria |
| None. |
| Follow-Up |
| 27 months (mean) |
| Treatment Regimen |
- Aspirin 300 mg/day or
- Warfarin (target INR 2.0-3.0) or
- No antithrombotic therapy
|
| Results |
| Primary Endpoint: Composite of death/nonfatal MI/nonfatal stroke. There was no significant difference in the primary endpoint in all 3 groups. All-cause hospitalizations was significantly increased in patients on aspirin compared to patients on warfarin or no antithrombotic (p=0.044), mainly due to worsening heart failure. Major bleeds were few (1 patient on aspirin, 4 patients on warfarin). The incidence of minor bleed was greater in the aspirin and warfarin groups compared to no antithrombotic (13%, 17%, and 5%, respectively, p=0.033). |
| Summary |
| Antithrombotic therapy with either aspirin or warfarin in all patients with systolic dysfunction heart failure is not beneficial. |
| Implications |
| None. |
| Related Figures |
| [12] |