Posted by: Chris Maloney | May 17, 2013

Is Warfarin Or Aspirin Better For Heart Failure?

Generic regular strength enteric coated 325mg ...

Generic regular strength enteric coated 325mg aspirin tablets, distributed by Target Corporation. The orange tablets are imprinted in black with “L429”. (Photo credit: Wikipedia)

The standard answer would be warfarin, but in an analysis of the studies it turns out that for patients with heart failure but normal heart rhythm, it makes no difference in overall outcome.

Warfarin patients had fewer strokes, including fewer bleeding strokes, but they tended to bleed more everywhere else. The overall effect on death rate was “neutral” meaning neither treatment was superior.

Since neither treatment was superior and warfarin patients bled more, the reviewers said aspirin was better overall.

Here’s the medline abstract:

Circ Heart Fail. 2013 Mar;6(2):287-92. doi: 10.1161/CIRCHEARTFAILURE.112.971697. Epub  2012 Dec 21.

Risk-benefit profile of warfarin versus aspirin in patients with heart failure and sinus rhythm: a meta-analysis.


Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.



The risk-benefit profile of warfarin versus aspirin for patients with heart failure in normal sinus rhythm has not been definitively established. Our objective was to evaluate the overall comparative effects of warfarin and aspirin in patients with heart failure and normal sinus rhythm.


Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, and from January 1966 to June 2012 were searched to identify relevant studies. We included randomized controlled trials that included comparison of warfarin versus aspirin, and composite end point of death or stroke separately for active treatment and control groups. Summary incidence rates, relative risks (RRs), and 95% confidence intervals (CIs) were calculated using random-effects models. The search identified 4 randomized controlled trials of warfarin versus aspirin therapy, enrolling 3663 patients. There was no significant difference between the 2 treatments for the primary end point (warfarin versus aspirin: RR, 0.94; 95% CI, 0.84-1.06; P=0.31). Warfarin (versus aspirin) was associated with lower risk of any stroke (RR, 0.56; 95% CI, 0.38-0.82; P=0.003) and ischemic stroke (RR, 0.45; 95% CI, 0.24-0.86; P=0.02) but had a neutral effect on death (RR, 1.01; 95% CI, 0.89-1.14; P=0.89) and a higher risk of major bleeding (RR, 1.95; 95% CI, 1.37-2.76; P=0.0002).


Compared with aspirin, warfarin does not provide benefit in the prevention of stroke and death among patients with heart failure in sinus rhythm, but raises the risk of major bleeding; and therefore its use in these patients is not justified.

PMID: 23264446


  1. Thanks for sharing this info.
    I just love the “had fewer” findings response.
    The words pharmacopoeia, pharmacology, pharmacy and pharmaceutical all come from the Greek word “pharmakon”. The word translates as drug and meaning both remedy and poison..We refer to both effective medicines and to toxic substances as drugs.
    The reason we need a prescription for pharmaceuticals is that they do harm to our bodies and a prescription is the way the government protects us from this harm.
    Please consider food a a remedy! Food has great power. Even the power to heal.
    “Primum non nocerum. (First do no harm)”
    ― Hippocrates

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