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CC BY 4.0 · TH Open 2020; 04(04): e383-e392
DOI: 10.1055/s-0040-1720961
Original Article

Efficacy and Safety of Oral Anticoagulants in Patients with Systolic Heart Failure in Sinus Rhythm: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Cohort Studies

Marie H. Nygaard
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
,
Anne-Mette Hvas 
2   Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
3   Department of Clinical Biochemistry, Thrombosis and Hemostasis Unit, Aarhus University Hospital, Aarhus, Denmark
,
Erik L. Grove 
1   Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
2   Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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Abstract

Introduction There is conflicting evidence on the risk–benefit ratio of oral anticoagulants (OAC) in heart failure (HF) patients without atrial fibrillation. We aimed to evaluate the efficacy and safety of OAC in HF patients in sinus rhythm.

Methods A systematic literature search was conducted using PubMed and Embase. We included randomized controlled trials (RCT) and cohort studies, comparing OAC with antiplatelet or no treatment/placebo in patients with HF. Outcomes evaluated were stroke, myocardial infarction (MI), all-cause mortality, and major bleeding.

Results Five RCTs and three cohort studies were included. OAC was associated with a reduced risk of ischemic stroke when compared with no treatment/placebo (odds ratio [OR] = 0.67, 95% confidence interval [CI]: [0.47, 0.94]) and antiplatelet therapy (OR = 0.55, 95% CI: [0.37, 0.81]). No significant reduction was found in MI, when OAC was compared with no treatment/placebo (OR = 0.82, 95% CI: [0.63, 1.07]) or antiplatelet therapy (OR = 1.04, 95% CI: [0.60, 1.81]). The all-cause mortality analysis showed no significant reduction when comparing OAC with no treatment/placebo (OR = 0.99, 95% CI: [0.87, 1.12]) or antiplatelet therapy (OR = 1.00, 95% CI: [0.86, 1.16]). The nonsignificant effect of OAC on all-cause mortality was supported by a meta-analysis of the three cohort studies (OR = 1.02, 95% CI: [0.75, 1.38]). Patients treated with OAC had a significantly higher risk of major bleeding than patients receiving antiplatelet therapy (OR = 2.16, 95% CI: [1.55, 3.00]) and a numerically higher risk when compared with no treatment/placebo (OR = 2.38, 95% CI: [0.87, 6.49]).

Conclusion The present study does not support the routine use of OAC in patients with HF in sinus rhythm.

Keywords

heart failure - oral anticoagulants - meta-analysis - sinus rhythm - warfarin - rivaroxaban

Supplementary Material



Publication History

Received: 14 May 2020

Accepted: 05 October 2020

Article published online:
30 November 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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