Previous meta-analyses have not recommended routine warfarin use in heart failure (HF) patients but included limited data on contemporary anticoagulants and practices. We conducted an updated meta-analysis considering newer literature evaluating rivaroxaban in this patient population. The aim of this meta-analysis was to assess if anticoagulation is associated with a decrease in all-cause mortality, myocardial infarction (MI), stroke, and hospitalization for HF exacerbation without an increased risk of major bleeding. A systematic search was conducted for randomized controlled trials to evaluate the use of antithrombotic therapy in patients with HF in sinus rhythm. Outcomes evaluated included all-cause mortality (ACM), non-fatal stroke, MI, hospitalization for HF exacerbation, and major bleeding. Five trials met criteria with a total of 9390 patients included. Four of the five trials evaluated warfarin use and one trial evaluated rivaroxaban. When anticoagulation was compared to control (antiplatelet and placebo groups), a significant reduction in ischemic stroke was found (OR 0.57; 95% CI, 0.42 to 0.78; P = 0.0005, I2 = 6.9%) and no significant difference was found in the risk of ACM, MI, or HF hospitalization. A significant increase in major bleeding was observed in the anticoagulation group when compared to the control group (OR 2.00; 95% CI, 1.45 to 2.75; P = < 0.0001, I2 = 25.79%). Anticoagulation in HF patients in normal sinus rhythm does not appear to reduce mortality rate, prevent MI, or decrease HF hospitalizations. Use reduces risk of ischemic stroke but is counterbalanced with an increase in major bleeding.
Today's Top 5
5. Keto-Friendly Cardiologist
4. Acute Stroke Intervention by a Cardiologist
Featured in today's #DocWire Trending #Homepage tweets: @joshualeskomd, @DrAsifQasim - for more, visit docwirenews.com and reach out to the editors @mydocwire.
Acute stroke intervention - by a cardiologist - what are your thoughts on this case? @drandrewsharp @mmamas1973 @ajaykirtane @willsuh76 @rwyeh @rajivxgulati @ShrillaB @ShaziaTHussain1 @fischman_david @DocSavageTJU @DrMarthaGulati @RogueRad #stroke #medshr— Dr Asif Qasim (@DrAsifQasim) August 13, 2019
3. Fish Oil Does Little for Heart Disease
2. Percutaneous Intervention with BP-DES Not More Effective than PP-DES Use
1. Pay Attention to First Degree Relatives
Study in #JACC says pay attention to 1st degree relatives. In 95% of cases with a heritable cardiac diagnosis for sudden death, the nearest affected relative was a first-degree relative. #FamilyHistory #HLBSpopOMICS #myPHGKB #genes #RareDisease @NIH_NHLBI https://t.co/RodgXUrLoy pic.twitter.com/AWhbdU7kTo— George Mensah, MD (@NHLBI_Translate) August 15, 2019