LVH Heart Doctor Co-Wrote Landmark Aspirin Study

A doctor co-authored a landmark study published Wednesday that aspirin and warfarin are equally effective for preventing a combined risk of death, stroke and cerebral hemorrhage in heart failure patients.

The 10-year study, co-authored by Dr. Ron Freudenberger, chief of cardiology at and medical director of the Heart and Vascular Center, was published May 2 in the New England Journal of Medicine. The Heart and Vascular Center was one of 168 study sites in 11 countries that participated.

"We now know that clinicians don't need to put heart failure patients with a normal heart rhythm on anticoagulants like warfarin, thus reducing the risk of bleeding," Freudenberger said in a news release.

"We can give patients aspirin and be reassured that it's not going to either worsen the heart failure or lead to increased risk of death," he said.

The results could mean that more doctors and their patients will choose less costly aspirin therapy. Unlike aspirin, warfarin requires a prescription and regular blood work to monitor clotting levels and adjust drug dosages.

Among the highlights:

• The Warfarin and Aspirin for Reduced Cardiac Ejection Fraction (WARCEF) trial is the largest double-blind comparison of these medications for heart failure, following 2,305 patients at 168 study sites in 11 countries on three continents.
• Lehigh Valley Health Network's Heart and Vascular Center was one of the participating sites and Ronald Freudenberger, MD, Chief of Cardiology and Medical Director of the Heart and Vascular Center was a co-author of the study.
• The combined risk of death, stroke, and cerebral hemorrhage was 7.47% per year for patients taking the blood-thinner warfarin, also known by its brand name Coumadin, and 7.93% per year for those taking aspirin -- a difference that is not statistically significant.
• Patients taking warfarin had close to half the stroke risk of those taking aspirin (0.72% vs. 1.36% per year).
• However, warfarin patients had more than twice the risk for major bleeding (1.80% vs. 0.87% per year). These results, the investigators say, cancel each other out. However, in patients followed four years or longer, there was evidence that warfarin may be more effective in preventing the combined outcome of death, stroke, and intracerebral hemorrhage.

For patients with heart failure, a weakened heart means a greater risk for blood clots that can lead to a stroke, which can be fatal or disabling. Aspirin prevents clotting and warfarin thins the blood, thus reducing the risk of stroke due to a clot or blockage in a cerebral artery.