In the end, it is thus only slightly smarter - or a little less clueless - as formerly. Given the n

Medical Journal, 18.04.2012
About the benefits of oral anticoagulation in patients with heart failure has long been debated. Clear recommendations are not come out. A study now provides new insights, but still leaves a certain helplessness.
There is evidence of increased procoagulant chest pain factors, the blood flow conditions as well as the composition of blood (hematocrit) chest pain be changed. Is chronic heart failure therefore per se an indication for antithrombotic therapy?
Difficult the decision is in heart failure patients in sinus rhythm. Since there is often a CHD as underlying disease, many doctors opt for antithrombotic therapy with platelet inhibitors ASA.
However, still a lack of randomized controlled studies to document the clinical benefits of aspirin specifically in heart failure - both in patients with and without ischemic heart disease.
Actually, one could argue, it would be appropriate, therefore, to launch a placebo-controlled study to determine whether patients with heart failure at all antithrombotic chest pain therapy chest pain - be it with aspirin or anticoagulants - require. WATCH trial fizzles
But for this it never came. Apparently there was despite sparse data situation as necessarily perceived ethical concerns, however, deprive patients with heart failure antithrombotic therapy.
A rather sad chapter headed here at the 2009 published WATCH study the history of research. chest pain In this three-arm study, oral anticoagulation with aspirin and aspirin should be again compared with clopidogrel.
Thus, the study according to the rules of statistical art had lost considerable significance. There were no significant differences between the three tested antithrombotic therapies.
Back remained perplexed experts. Their eyes were as a result of the already launched in late 2002 WARCEF study, of which one finally hoping for clarification. Also, this study (325 mg / day) and placebo group without anticoagulation as a double-blind comparison of aspirin (warfarin, target INR: 2.0-3.5) were designed.
In eleven countries in total 2305 patients with heart failure (ejection fraction 35 percent) and normal sinus rhythm have been recorded. The results were recently presented at the "International Stroke Conference" in New Orleans. chest pain Little wiser, less loss
The observation period was 3.5 years on average. At the end of the investigators had to admit: In terms of the incidence rate for the primary endpoint (death, ischemic chest pain stroke, cerebral hemorrhage) was not a significant superiority of one or other therapy to determine (7.93 percent / year for aspirin, 7.47 percent / year for warfarin).
Although it has been the rate of ischemic stroke by warfarin compared to aspirin significantly reduced (29 versus 55 events), but at the cost of a significant increase in serious, especially gastrointestinal bleeding.
Among the stroke, chest pain the study provides no compelling evidence for routinely to treat all patients with heart failure with an anticoagulant such as warfarin or aspirin, the study authors conclude.
In the end, it is thus only slightly smarter - or a little less clueless - as formerly. Given the now documented equality chest pain of clinical benefit is likely to continue rather fall on SSA in the case of a deemed necessary antithrombotic therapy choice.
Whether you have made the right choice for the benefit of patients with heart failure and really prevents thromboembolism and stroke in them, also WARCEF can not answer with certainty.
Topic Keywords heart failure (580) Internal Medicine chest pain (30700) diseases cardiac rhythm disorders (836) heart failure (1526), CHD (1664) Stroke (2431) agents clopidogrel (375) Warfarin (142) persons chest pain Peter Overbeck (310)
Heart failure plus atrial fibrillation: Beta-blockers without benefit chest pain study shows: Low bone density - often heart failure coronary heart disease plus sleep apnea: signal for longer life with PAP ESC Congress: chest pain heart disease and depressed - not a good prognosis hsCRP: Note on prognosis of diastolic heart failure comment: A great success in of heart failure heart failure therapy: New drug represents ACE inhibitors in the shadow Telemedicine: Passenger patient contact pays off MyoVasc study: causes of heart failure on the track heart failure guidelines: enhancement of aldosterone antagonists
Treatment with beta-blockers proven to reduce mortality in patients with heart failure. Is in addition to heart failure or atrial fibrillation, the benefits go but apparently lost, as now show study results surprising.