Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.

<h4>Background</h4>Heart failure (HF) patients show high morbidity and mortality rate with increased risk of malignant arrhythmia and thromboembolism. Anticoagulation reduces embolic event and death rates in HF patients with atrial fibrillation, but if antithrombotic therapy is beneficia...

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Autores principales:	Giuseppe Rengo, Gennaro Pagano, Alessandro Squizzato, Lorenzo Moja, Grazia Daniela Femminella, Claudio de Lucia, Klara Komici, Valentina Parisi, Gianluigi Savarese, Nicola Ferrara, Pasquale Perrone-Filardi, Dario Leosco
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2013
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/99d2a42047124350afd7c8aa8c7791dc
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spelling	oai:doaj.org-article:99d2a42047124350afd7c8aa8c7791dc2021-11-18T08:02:53ZOral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.1932-620310.1371/journal.pone.0052952https://doaj.org/article/99d2a42047124350afd7c8aa8c7791dc2013-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23301006/pdf/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>Heart failure (HF) patients show high morbidity and mortality rate with increased risk of malignant arrhythmia and thromboembolism. Anticoagulation reduces embolic event and death rates in HF patients with atrial fibrillation, but if antithrombotic therapy is beneficial in patients with HF in sinus rhythm is still debated.<h4>Methodology and principal findings</h4>We conducted a systematic review of prospective, randomized controlled trials (RCTs) to assess the efficacy and safety of oral anticoagulant therapies (OATs) compared to antiplatelet treatment in HF patients in sinus rhythm. MEDLINE, Web of Science, CENTRAL and Scopus databases were searched up to May 2012. Four RCTs were identified and a total of 3663 patients were included in the meta-analysis. Patients with both ischemic and non-ischemic HF were included. There was no significant difference in mortality (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.86 to 1.19) between OATs group and antiplatelet drug group. OATs have reduced ischemic stroke risk (OR 0.49, 95% CI 0.32 to 0.74), but have increased major bleeding risk (OR 2.01, 95% CI 1.40 to 2.88) compared to antiplatelet treatment.<h4>Conclusion</h4>In HF patients in sinus rhythm OATs do not show a better risk-benefit profile compared to antiplatelet treatment in cardioembolism prevention. Warfarin and aspirin seem to be similar in reducing mortality. Warfarin reduces the incidence of ischemic stroke, but increases major bleedings. Thus, it is possible to speculate that aspirin prescription be indicated in patients with high risk of bleeding, whereas warfarin could be preferred in patients with high thromboembolic risk.Giuseppe RengoGennaro PaganoAlessandro SquizzatoLorenzo MojaGrazia Daniela FemminellaClaudio de LuciaKlara KomiciValentina ParisiGianluigi SavareseNicola FerraraPasquale Perrone-FilardiDario LeoscoPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 8, Iss 1, p e52952 (2013)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Giuseppe Rengo Gennaro Pagano Alessandro Squizzato Lorenzo Moja Grazia Daniela Femminella Claudio de Lucia Klara Komici Valentina Parisi Gianluigi Savarese Nicola Ferrara Pasquale Perrone-Filardi Dario Leosco Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
description	<h4>Background</h4>Heart failure (HF) patients show high morbidity and mortality rate with increased risk of malignant arrhythmia and thromboembolism. Anticoagulation reduces embolic event and death rates in HF patients with atrial fibrillation, but if antithrombotic therapy is beneficial in patients with HF in sinus rhythm is still debated.<h4>Methodology and principal findings</h4>We conducted a systematic review of prospective, randomized controlled trials (RCTs) to assess the efficacy and safety of oral anticoagulant therapies (OATs) compared to antiplatelet treatment in HF patients in sinus rhythm. MEDLINE, Web of Science, CENTRAL and Scopus databases were searched up to May 2012. Four RCTs were identified and a total of 3663 patients were included in the meta-analysis. Patients with both ischemic and non-ischemic HF were included. There was no significant difference in mortality (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.86 to 1.19) between OATs group and antiplatelet drug group. OATs have reduced ischemic stroke risk (OR 0.49, 95% CI 0.32 to 0.74), but have increased major bleeding risk (OR 2.01, 95% CI 1.40 to 2.88) compared to antiplatelet treatment.<h4>Conclusion</h4>In HF patients in sinus rhythm OATs do not show a better risk-benefit profile compared to antiplatelet treatment in cardioembolism prevention. Warfarin and aspirin seem to be similar in reducing mortality. Warfarin reduces the incidence of ischemic stroke, but increases major bleedings. Thus, it is possible to speculate that aspirin prescription be indicated in patients with high risk of bleeding, whereas warfarin could be preferred in patients with high thromboembolic risk.
format	article
author	Giuseppe Rengo Gennaro Pagano Alessandro Squizzato Lorenzo Moja Grazia Daniela Femminella Claudio de Lucia Klara Komici Valentina Parisi Gianluigi Savarese Nicola Ferrara Pasquale Perrone-Filardi Dario Leosco
author_facet	Giuseppe Rengo Gennaro Pagano Alessandro Squizzato Lorenzo Moja Grazia Daniela Femminella Claudio de Lucia Klara Komici Valentina Parisi Gianluigi Savarese Nicola Ferrara Pasquale Perrone-Filardi Dario Leosco
author_sort	Giuseppe Rengo
title	Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
title_short	Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
title_full	Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
title_fullStr	Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
title_full_unstemmed	Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
title_sort	oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.
publisher	Public Library of Science (PLoS)
publishDate	2013
url	https://doaj.org/article/99d2a42047124350afd7c8aa8c7791dc
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Oral anticoagulation therapy in heart failure patients in sinus rhythm: a systematic review and meta-analysis.

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