1. Benefit of Warfarin Compared With Aspirin in Patients With Heart Failure in Sinus Rhythm
- Author
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Homma, Shunichi, Thompson, John LP, Sanford, Alexandra R, Mann, Douglas L, Sacco, Ralph L, Levin, Bruce, Pullicino, Patrick M, Freudenberger, Ronald S, Teerlink, John R, Graham, Susan, Mohr, JP, Massie, Barry M, Labovitz, Arthur J, Di Tullio, Marco R, Gabriel, André P, Lip, Gregory YH, Estol, Conrado J, Lok, Dirk J, Ponikowski, Piotr, and Anker, Stefan D
- Subjects
Biomedical and Clinical Sciences ,Cardiovascular Medicine and Haematology ,Clinical Research ,Cardiovascular ,Stroke ,Brain Disorders ,Adult ,Age Factors ,Aged ,Anticoagulants ,Aspirin ,Brain Ischemia ,Cerebral Hemorrhage ,Double-Blind Method ,Female ,Heart Failure ,Heart Rate ,Humans ,Kaplan-Meier Estimate ,Male ,Middle Aged ,Proportional Hazards Models ,Risk Factors ,Stroke Volume ,Time Factors ,Treatment Outcome ,Ventricular Function ,Left ,Warfarin ,aspirin ,heart failure ,sinus rhythm ,stroke ,warfarin ,WARCEF Investigators ,Biochemistry and Cell Biology ,Cardiorespiratory Medicine and Haematology ,Medical Physiology ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Medical physiology - Abstract
BackgroundThe Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial found no difference in the primary outcome between warfarin and aspirin in 2305 patients with reduced left ventricular ejection fraction in sinus rhythm. However, it is unknown whether any subgroups benefit from warfarin or aspirin.Methods and resultsWe used a Cox model stepwise selection procedure to identify subgroups that may benefit from warfarin or aspirin on the WARCEF primary outcome. A secondary analysis added major hemorrhage to the outcome. The primary efficacy outcome was time to the first to occur of ischemic stroke, intracerebral hemorrhage, or death. Only age group was a significant treatment effect modifier (P for interaction, 0.003). Younger patients benefited from warfarin over aspirin on the primary outcome (4.81 versus 6.76 events per 100 patient-years: hazard ratio, 0.63; 95% confidence interval, 0.48-0.84; P=0.001). In older patients, therapies did not differ (9.91 versus 9.01 events per 100 patient-years: hazard ratio, 1.09; 95% confidence interval, 0.88-1.35; P=0.44). With major hemorrhage added, in younger patients the event rate remained lower for warfarin than aspirin (5.41 versus 7.25 per 100 patient-years: hazard ratio, 0.68; 95% confidence interval, 0.52-0.89; P=0.005), but in older patients it became significantly higher for warfarin (11.80 versus 9.35 per 100 patient-years: hazard ratio, 1.25; 95% confidence interval, 1.02-1.53; P=0.03).ConclusionsIn patients
- Published
- 2013