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May 16, 2012

Warfarin vs. Aspirin in Heart Failure Patients

Many have wondered if prescribing warfarin might benefit heart failure patients even more, given its strength compared to aspirin.

Heart failure occurs when the heart becomes too weak or stiff to pump enough blood to the rest of the body. Because heart failure slows the flow of blood through the heart, it is more likely that patients with heart failure develop blood clots, which are the most common cause of stroke. As a result, not only does heart failure increase risk for stroke, it can also increase risk for an abnormal heart rhythm, known as atrial fibrillation, which can further increase stroke risk.

Fortunately, there are a number of ways that patients can reduce stroke risk, like by taking blood thinners. Blood thinners are a type of medication that can help prevent the formation of blood clots or prevent existing blood clots from getting larger. Some blood thinners, such as aspirin, are over the counter, while others, like warfarin, are stronger and only given out with a prescription. Typically, doctors prescribe aspirin for patients with heart failure to help reduce risk for stroke, because it has less side effects and risk of complications. However, many have wondered if prescribing warfarin might benefit heart failure patients even more, given its strength compared to aspirin. And based on a recent study published in the New England Journal of Medicine, the answer is - it depends.

As part of this study, researchers followed more than 2,300 patients with heart failure for up to 6 years, keeping close track any strokes and deaths that occurred during this follow-up period. Overall, they found that there was no significant difference between aspirin and warfarin in reducing overall risk for death. However, patients taking warfarin had significantly less risk of ischemic stroke (stroke caused by a blood clot) compared to those taking aspirin.  Unfortunately, those taking warfarin also had significantly greater risk of bleeding when compared to patients taking aspirin.

Based on these findings, there is no evidence that warfarin should be universally prescribed to heart failure patients instead of aspirin. Instead, the decision to take warfarin vs. aspirin should be made on an individual basis with your health care provider, based on the risks, benefits and alternatives for each patient. Warfarin may be appropriate for patients with extremely high risk of stroke – like those with heart disease or atrial fibrillation. On the other hand, aspirin may be better suited for patients with lower stroke risk and increased bleeding risk. 

Questions for You to Consider

  • What is warfarin?

  • Warfarin is a type of anticoagulant (blood thinner) that helps prevent blood clots from forming or prevents existing blood clots from getting larger. Common brand names for warfarin include Coumadin, Jantoven and Marfarin.

  • What are the possible complications from heart failure?

  • Aside from increasing risk for heart attack and stroke, heart failure can cause kidney damage or failure, liver damage and heart valve problems. However, risk for such complications may be reduced with proper treatment.