Study: Aspirin as Effective as Warfarin

Aspirin works as well as the blood thinner warfarin, or Coumadin, in most patients with heart failure when it comes to preventing death, stroke, or brain hemorrhage, according to a major international study released Wednesday. The findings published in the New England Journal of Medicine came from a landmark clinical trial that lasted 10 years and tracked 2,305 patients in 11 countries. The combined risk of death, stroke, and cerebral hemorrhage was 7.47 percent per year for patients taking warfarin, and 7.93 percent per year for those taking aspirin, a difference that researchers said was not statistically significant. Patients taking the blood thinner had half the stroke risk of people taking aspirin, but warfarin patients had double the risk for major bleeding, and so those two factors cancelled each other out, researchers said. There was some evidence among warfarin patients followed for four years or more that the blood thinner may have superior benefits in warding off death, stroke, or brain hemorrhage, but more analysis is needed, the study said. "Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs," said lead investigator Shunichi Homma of Columbia University Medical Center. "However, given the convenience and low cost of aspirin, many may go this route." Heart failure can hike the risk of blood clots that may cause stroke. Aspirin prevents the blood from clotting and warfarin, available by prescription, thins the blood. "With at least six million Americans — and many more around the world — suffering from heart failure, the results of the WARCEF (Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction) study will have a large public health impact," said Walter Koroshetz, deputy director of the National Institute for Neurological Disorders and Stroke. "The key decision will be whether to accept the increased risk of stroke with aspirin, or the increased risk of primarily gastrointestinal hemorrhage with warfarin," he said.