Does anticoagulation therapy influence outcomes in patients with heart failure and sinus rhythm?

  • Beggs SAS & al.
  • Heart
  • 8 Apr 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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Takeaway

  • This meta-analysis suggests that anticoagulation treatment is not associated with reduction in all-cause mortality, readmission for heart failure and myocardial infarction (MI) in patients with heart failure and sinus rhythm.

Why this matters

  • Findings strengthen current guideline recommendations that heart failure with reduced ejection fraction is not by itself an indication for anticoagulation.

Study design

  • 5 studies involving over 9000 patients met eligibility criteria after a search on PubMed, Medline and the Cochrane Controlled Register of Trials.
  • Funding: None disclosed.

Key results

  • Compared with the control group, anticoagulant treatment was not associated with reduction in:
    • all-cause mortality (risk ratio [RR], 0.99; 95% CI, 0.90-1.08),
    • hospitalisation for heart failure (RR, 0.97; 95% CI; 0.82-1.13),
    • non-fatal stroke (RR, 0.63; 95% CI, 0.49-0.81; P=.001).
  • Anticoagulation treatment was associated with significant reduction in non-fatal MI vs control group (RR, 0.92; 95% CI, 0.75-1.13).
  • Anticoagulation therapy was associated with significant increase in the risk of a major haemorrhage (RR, 1.88; 95% CI, 1.49-2.38, P<.001>

Limitations

  • Analysis used trial-level data rather than patient-level data.

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