Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis

Beggs, S. A.S. , Rørth, R., Gardner, R. S. and McMurray, J. J.V. (2019) Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis. Heart, (doi:10.1136/heartjnl-2018-314381) (PMID:30962190) (Early Online Publication)

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Abstract

Objective: Heart failure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heart failure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm. Methods: We conducted an updated systematic review and meta-analysis to examine the effect of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heart failure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage. Results: Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment did not reduce all-cause mortality (risk ratio [RR] 0.99, 95% CI 0.90 to 1.08), (re)hospitalisation for heart failure (RR 0.97, 95% CI 0.82 to 1.13) or non-fatal myocardial infarction (RR 0.92, 95% CI 0.75 to 1.13). Anticoagulation did reduce the rate of non-fatal stroke (RR 0.63, 95% CI 0.49 to 0.81, p=0.001), but this was offset by an increase in the incidence of major haemorrhage (RR 1.88, 95% CI 1.49 to 2.38, p=0.001). Conclusions: Our meta-analysis provides evidence to oppose the hypothesis that thrombosis or embolism plays an important role in the morbidity and mortality associated with HFrEF, with the exception of stroke-related morbidity.

Item Type:Articles
Status:Early Online Publication
Refereed:Yes
Glasgow Author(s) Enlighten ID:Roerth, Dr Rasmus and McMurray, Professor John and Gardner, Professor Roy and Beggs, Dr Simon
Authors: Beggs, S. A.S., Rørth, R., Gardner, R. S., and McMurray, J. J.V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN:1355-6037
ISSN (Online):1468-201X
Published Online:08 April 2019
Copyright Holders:Copyright © 2019 The Authors
First Published:First published in Heart 2019
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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