Warfarin and Aspirin in Patients with Heart Failure and Sinus Rhythm
Shunichi Homma,John L.P. Thompson,Patrick M. Pullicino,Bruce Levin,Ronald S. Freudenberger,John R. Teerlink,John R. Teerlink,Susan E. Ammon,Susan Graham,Ralph L. Sacco,Douglas L. Mann,Jay P. Mohr,Barry M. Massie,Barry M. Massie,Arthur J. Labovitz,Stefan D. Anker,Dirk J. Lok,Piotr Ponikowski,Conrado J. Estol,Gregory Y.H. Lip,Marco R. Di Tullio,Alexandra R. Sanford,Vilma Mejia,André P. Gabriel,Mirna Del Valle,Richard Buchsbaum,C. Moy,P. Gilbert,Laurie Gutmann,J. Marler,S. Borden,E. Peña,C. Harris,R. Khadouri,D. Gohs,Martin M. Brown,G. Berry,D. Disantis,M. Scullin,Peter K. Smith,Shun Kohsaka,W. Watson,L. Guillory,Gilberto Levy,K. Tea,Johnston Grier,L. Swydan,B. O'Hare,R. Prodhan,R. Arbing,E. Flanagan,E. Duverger,A. Peljto,W. Lo,A. Tierney,A. Henriquez,J. Keen,G. J. del Zoppo,Gregory W. Albers,M. Eliasziw,J. A. Hinchey,K. C. Johnston,April M. Lowe,Ileana L. Piña,J. A. Swain,S. Slomiak,L. Cape,H. J. Barnett,A. Bruno,J. D. Easton,Steven R. Levine,Demetrios J. Sahlas,F. Bleyer,Peter E. Carson,A. Ellis,Alan B. Miller,S. T. Palmeri,Michelle Bierig,R. Liu,C. Donato,Robert G. Hart,C. McKay,L. Wilson,E. Frey,K. Hayward,P. Stein-Beal,L. Konczarek,M. Diek,M. Rohwedder,M. Bohdanowicz-Zazula,C. F. Peerenboom-Fey,M. Vissiennon,G. Rex,M. Varga,O. Kovtun,V. Orlyk,Petr Arenberger,J. Jaros,A. Ruiz,M. Zimmermann,A. Ellenberg,A. Minagar,R. Kelley,J. McGee,P. Jinkins,S. Bezucha,V. Hart,M. Bonora,R. Sawyer,K. Ammerman,P. Ramappa,V. Berchou,E. Jones,E. Olgren,B. Hattler,C. Anderson,B. Watson,D. Wolf,J. Kosits,L. Casazza,D. Yip,J. Meschia,A. McPhail,K. Greenan,R. Rothbart,J. Love,T. Schrader,V. Garman,Marcus F. Stoddard,K. Remmel,R. Longaker,Christine Gerula,Marc Klapholz,J. Kirmani,R. Mattessich,Carlos J. Rodriguez,W. Graettinger,Andrew H. Baker,A. Valencia,P. Kosolcharoen,L. Williams,V. Sorrell,B. Coull,D. Bruck,Elizabeth O. Ofili,M. Frankel,P. Jackson,M. Nanna,S. Sparr,W. Almeida,R. Libman,B. Stephens,C. DeMers,T. Giles,L. Roffidal,D. Barratt,M. Liston,C. Lindsey,L. Giron,W. Felton,L. Joseph,M. Lee,J. Bisognano,C. Benesch,L. Caufield,E. Nishime,M. Moussavian,E. Polland,L. Fischer,K. Peterson,B. McGinnis,M. Tilem,G. Allam,J. Beebe,P. Chang,Sedat Sen,C. Schuler,L. Arcement,M. Charlet,E. Falgout,M. Malkowski,T. Dugan,J. Hobbs-Williams,A. Warner,K. Panizzon,J. Johnson,J. Dissin,D. Karia,N. Molakala,B. Dandapani,R. Vicari,E. Anthony,I. Katzan,Richard J. Hobbs,A. Richmond,Richard L. Hughes,W. Baker,M. Applegate,B. Drachman,Sami Khella,S. Donovan,A. Slim,D. Pearce Moore,B. Darrow,A. Travis,A. Mercando,R. Pellegrino,N. Jarmukli,T. Ochalek,Denise L. Janosik,J. Dizes,L. C. Pettigrew,D. Taylor,J. Hanna,S. Bailey,R. Berkowitz,S. Mathus,V. Virkud,S. Shaw,S. Nabhan,E. Wirkowski,B. George,Eric E. Smith,S. Locke,C. Landau,D. Ferguson,H. V. Anderson,L. Westbrook,M. Apelian,S. Khoury,J. Leppo,T. Bator,Udho Thadani,J. Turner,Steven Goldman,S. Daugherty,A. Adler,T. Rennie,D. Chupka,R. Katz,L. Witkin,W. Burgin,Ceri Weber,John P. Boehmer,P. Frey,M. Wilson,H. Tworek,G. Mallis,D. Mauceri,R. Schneider,W. Schneider,G. Ortiz,M. Lichtenberger,B. Hott,Donald L. Patrick,Stephanie Hope Dunlap,S. J. Kim,S. Pezzella,D. Aubin,L. Nikolaidis,J. Wong,D. Leifer,M. Rossi,G. Torre,J. Arredondo,J. Lynch,A. Metcalf,J. Gonzalez,B. Donley,Thomas P. Cappola,K. Craig,Biykem Bozkurt,Mariana Bolos,T. Noonan,C. Alteri,L. Kowalczyk,A. Cwynar,D. Drazek,Jan Biegus,Roman Szełemej,M. Jurczok,R. Serafin,A. Jurczyk,M. Ogorek,D. Kopcik,B. Metzkier-Wyrwa,A. Szczepanska,M. Dluzniewski,W. Wicha,M. Kuch,K. Kuc,R. Piotrowski,O. Lesniak,M. Krauze-Wielicka,J. Herman,S. Nowakowska,Tomasz J. Pasierski,B. Kozlowski,K. Wolkowska,A. Juszczak,J. Michalska,I. Jedlinski,P. Miekus,M. Konarzewski,P. Berkowski,N. Jacek,Zbigniew Kalarus,A. Duszanska,J. Tarchalski,P. Czaja,Zbigniew Gaciong,J. Gora,A. Kleinrok,G. Prokop-Lewicka,Haissam Haddad,R. Davies,L. Sitwell,J. Donaldson,T. To,R. Yufe,B. Donelly,T. Huynh,Robert Côté,B. St Jacques,D. Borts,G. Tullio,A. M. Sindilar,T. Winder,E. Janzen,C. Walker,G. Moe,N. Bayer,A. Konig,Malcolm Arnold,David Spence,J. Smith,R. Bessoudo,P. Bailey,A. McNulty,S. Nawaz,C. Dewar,M. Rajda,M. MacFarlane,J. Minuk,C. Schanz,Andrew M Penn,L. Atkins,A. Ducharme,H. Brown,Shelley Zieroth,A. Muñoz,J. B. ten Holter,C. Huls,P. Bruggink-Andre,A. van Bujisen-Nutters,M. Daniels,A. Coppes,M. van Zagten,N. Elzebroek,K. Hamroui,P. de Kort,J. Vuijsters,N. Holwerda,W. Hermans,R. van der Loo,Elly M.C.J. Wajon,G. Hageman,G. v Buchem-Damming,E. Ronner,A. Wissenburg-van Lieshout,H. Niekus,M. W. van Hessen,G. A. Verheul,G. Linssen,L. te Pas,J. Plomp,P. A. de Milliano,R. Breedveld,M. J. Bos,M. Houra,D. Beran,R. Lebedova,J. Carda,E. Bednarova,J. Vosmerova,G. Marcinek,T. Drasnar,O. Najmanova,M. Dunaj,E. Pechackova,M. Kuchar,P. Jansky,J. Simon,H. Dvorakova,P. Gregor,M. Maruskova,L. Svoboda,Z. Lorenc,P. Kralicek,L. Pollak,Z. Krobot,M. Krobot,Jindřich Špinar,M. Nemec,L. Spinarova,R. Kuba,F. Padour,I. Padourova,M. Padour,M. Michalova,L. Golan,M. Hajkova,J. Povolny,L. Krizova,D. Horak,P. Kucera,I. Malek,B. Krizova,J. Svoboda,R. Ferkl,L. Regos,L. Csuros,O. Lovasz,G. Kiss,S. Timar,N. Torok,A. Hajnalne,B. Palossy,A. Nagy,P. Fulop,G. Jakab,A. Ronaszeki,M. Bodi,M. Satori,I. Edes,I. Varga,Attila Kovacs,L. Berente,E. Péterfai,R. Pauer,K. Toth,E. Nagy,B. Benczur,K. Karsay,T. Vegh,R. Nagy,P. Karpati,Z. Davidovits,J. Borbola,J. Vanyi,B. Oze,A. Bujdoso,I. Kosa,L. Baliko,M. Natour,M. Morgil,E. Hartmann,H. Morgil,R. Winkler,S. Gass,S. Baumann,M. Jeserich,J. Rodl,M. Dzaiy,G. Turhan,K. Wolf,S. Genth-Zotz,T. Siebert,C. Jakobs,M. Kiorwantsi,Burkert Pieske,R. Wachter,M. Schoenauer,S. Voigt,H. Schunkert,A. Boguschewski,M. Resch,R. Wensel,V. Schumann,P. Heidrich,O. Girina,Y. Prokopovych,M. Lebedynska,I. Sorokina,O. Karpenko,N. Brodi,S. Klochkov,L. Voronkov,Y. Besaga,O. Novikova,K. Amosova,O. Yaremenko,K. Balaban,V. Kovalenko,N. Polenova,I. Sakharchuk,A. Ogorodnichuk,L. Rudenko,Y. Tutov,A. Parkhomenko,S. Kozhukhov,E. Yakimenko,S. Kolomiets,V. Yurlov,S. Tikhonova,A. Elizalde,B. Mangariello,C. Zaidman,F. Guerlloy,P. Gitelman,K. Crotto,S. Sassone,J. Aiub,F. Novoa,R. Lopez Santi,P. Romia,O. Montaña,D. Malchik,F. Sokn,P. Schygiel,R. Porcile,F. Soria Tito,J. Thierer,P. Avellana,C. Rapallo,M. Calderon,R. MacFadyen,R. Haynes,J. Partridge,M. Kokles,S. Mehešová,A. Zachar,M. Hranai,T. Varadyova,T. Göbö,J. Litvinova,P. Loviska +536 more
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There was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin among patients with reduced LVEF who were in sinus rhythm, and a reduced risk of ischemic stroke withwarfarin was offset by an increased risk of major hemorrhage.Abstract:
BACKGROUND It is unknown whether warfarin or aspirin therapy is superior for patients with heart failure who are in sinus rhythm. METHODS We designed this trial to determine whether warfarin (with a target international normalized ratio of 2.0 to 3.5) or aspirin (at a dose of 325 mg per day) is a better treatment for patients in sinus rhythm who have a reduced left ventricular ejection fraction (LVEF). We followed 2305 patients for up to 6 years (mean [±SD], 3.5±1.8). The primary outcome was the time to the first event in a composite end point of ischemic stroke, intracerebral hemorrhage, or death from any cause. RESULTS The rates of the primary outcome were 7.47 events per 100 patient-years in the warfarin group and 7.93 in the aspirin group (hazard ratio with warfarin, 0.93; 95% confidence interval [CI], 0.79 to 1.10; P = 0.40). Thus, there was no significant overall difference between the two treatments. In a time-varying analysis, the hazard ratio changed over time, slightly favoring warfarin over aspirin by the fourth year of follow-up, but this finding was only marginally significant (P = 0.046). Warfarin, as compared with aspirin, was associated with a significant reduction in the rate of ischemic stroke throughout the follow-up period (0.72 events per 100 patient-years vs. 1.36 per 100 patient-years; hazard ratio, 0.52; 95% CI, 0.33 to 0.82; P = 0.005). The rate of major hemorrhage was 1.78 events per 100 patient-years in the warfarin group as compared with 0.87 in the aspirin group (P<0.001). The rates of intracerebral and intracranial hemorrhage did not differ significantly between the two treatment groups (0.27 events per 100 patient-years with warfarin and 0.22 with aspirin, P = 0.82). CONCLUSIONS Among patients with reduced LVEF who were in sinus rhythm, there was no significant overall difference in the primary outcome between treatment with warfarin and treatment with aspirin. A reduced risk of ischemic stroke with warfarin was offset by an increased risk of major hemorrhage. The choice between warfarin and aspirin should be individualized. (Funded by the National Institute of Neurological Disorders and Stroke; WARCEF ClinicalTrials.gov number, NCT00041938.)read more
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC.
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer,Gerasimos Filippatos,John J.V. McMurray,Victor Aboyans,Stephan Achenbach,Stefan Agewall,Nawwar Al-Attar,John Atherton,Johann Bauersachs,A. John Camm,Scipione Carerj,Claudio Ceconi,Antonio Coca,Perry M. Elliott,Çetin Erol,Justin A. Ezekowitz,Covadonga Fernández-Golfín,Donna Fitzsimons,Marco Guazzi,Maxime Guenoun,Gerd Hasenfuss,Gerhard Hindricks,Arno W. Hoes,Bernard Iung,Tiny Jaarsma,Paulus Kirchhof,Juhani Knuuti,Philippe Kolh,Stavros Konstantinides,Mitja Lainscak,Patrizio Lancellotti,Gregory Y.H. Lip,Francesco Maisano,Christian Mueller,Mark C. Petrie,Massimo F Piepoli,Silvia G. Priori,Adam Torbicki,Hiroyuki Tsutsui,Dirk J. van Veldhuisen,Stephan Windecker,Clyde W. Yancy,José Luis Zamorano +62 more
TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Journal ArticleDOI
2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
Clyde W. Yancy,Mariell Jessup,Biykem Bozkurt,Javed Butler,Donald E. Casey,Mark H. Drazner,Gregg C. Fonarow,Stephen A. Geraci,Tamara B. Horwich,James L. Januzzi,Maryl R. Johnson,Edward K. Kasper,Wayne C. Levy,Frederick A. Masoudi,Patrick E. McBride,John J.V. McMurray,Judith E. Mitchell,Pamela N. Peterson,Barbara Riegel,Flora Sam,Lynne W. Stevenson,W.H. Wilson Tang,Emily J. Tsai,Bruce L. Wilkoff +23 more
TL;DR: In this article, Anderson et al. proposed a new FAHA Chair, Jeffrey L. Anderson, MD, FACC, FAHA, Chair-Elect, Alice K. Jacobs et al., this article and Biykem Bozkurt.
Journal ArticleDOI
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer +20 more
TL;DR: ACCF/AHAIAI: angiotensin-converting enzyme inhibitor as discussed by the authors, angio-catabolizing enzyme inhibitor inhibitor inhibitor (ACS inhibitor) is a drug that is used to prevent atrial fibrillation.
Journal ArticleDOI
2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure
Piotr Ponikowski,Adriaan A. Voors,Stefan D. Anker,Héctor Bueno,John G.F. Cleland,Andrew J.S. Coats,Volkmar Falk,José Ramón González-Juanatey,Veli-Pekka Harjola,Ewa A. Jankowska,Mariell Jessup,Cecilia Linde,Petros Nihoyannopoulos,John Parissis,Burkert Pieske,Jillian P. Riley,Giuseppe M.C. Rosano,Luis M. Ruilope,Frank Ruschitzka,Frans H. Rutten,Peter van der Meer +20 more
TL;DR: Authors/Task Force Members: Piotr Ponikowski* (Chairperson) (Poland), Adriaan A. Voors* (Co-Chair person) (The Netherlands), Stefan D. Anker (Germany), Héctor Bueno (Spain), John G. F. Cleland (UK), Andrew J. S. Coats (UK)
Journal ArticleDOI
ESC Guidelines for the Diagnosis And Treatment of Acute And Chronic Heart Failure 2008
Kenneth Dickstein,Alain Cohen-Solal,Gerasimos Filippatos,John J.V. McMurray,Piotr Ponikowski,Philip A. Poole-Wilson,Anna Strömberg,Dirk J. van Veldhuisen,Dan Atar,Arno W. Hoes,Andre Keren,Alexandre Mebazaa,Markku S. Nieminen,Silvia G. Priori,Karl Swedberg +14 more
TL;DR: Authors/Task Force Members: John J. McMurray (Chairperson) (UK), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Angelo Auricchio (Switzerland), Michael Böhm ( Germany), Kenneth Dickstein (Norway), Volkmar Falk (Sw Switzerland), Gerasimos Filippatos (G Greece), Cândida Fonseca (Portugal), Miguel Angel Gomez-Sanchez (Spain).
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2013 ACCF/AHA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines
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