Warfarin anticoagulation and survival: a cohort analysis from the Studies of Left Ventricular Dysfunction
AS Al-Khadra,
DN Salem,
WM Rand,
JE Udelson,
JJ Smith,
and
MA Konstam
Department of Medicine, New England Medical Center Hospitals, Tufts University School of Medicine, Boston, Massachusetts 02111, USA.
OBJECTIVES: We sought to evaluate the relation between warfarin anticoagulation and survival and morbidity from cardiac disease in patients with left ventricular (LV) dysfunction. BACKGROUND: Warfarin anticoagulation plays a major role in the management of patients who have had a large myocardial infarction and in those with atrial fibrillation. However, its use in patients with LV systolic dysfunction has been controversial. METHODS: We reviewed data on warfarin use in 6,797 patients enrolled in the Studies of Left Ventricular Dysfunction (SOLVD) trial and analyzed the relation between warfarin use and all-cause mortality, as well as the combined end point of death or hospital admission for heart failure. We used Cox regression to adjust for differences in baseline characteristics and to test for the interaction between warfarin use and selected patient variables in relation to outcome. RESULTS: On multivariate analysis, use of warfarin was associated with a significant reduction in all-cause mortality (adjusted hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.65 to 0.89, p = 0.0006) and in the risk of death or hospital admission for heart failure (HR 0.82, 95% CI 0.72 to 0.93, p = 0.0002). Risk reduction was observed when each trial or randomization arm was analyzed separately, as well as in both genders. It was not significantly influenced by the presence of atrial fibrillation, age, ejection fraction, New York Heart Association functional class or etiology. CONCLUSIONS: In patients with LV systolic dysfunction, warfarin use is associated with improved survival and reduced morbidity. This association is primarily due to a reduction in cardiac events and does not appear to be limited to any particular subgroup.
This article has been cited by other articles:
|
|
|
|
 
S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation
J. Am. Coll. Cardiol.,
April 14, 2009;
53(15):
e1 - e90.
[Full Text]
[PDF]
|
|
|
|
|
|
|
2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al.
2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation
Circulation,
April 14, 2009;
119(14):
e391 - e479.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Konstam
Antithrombotic Therapy in Heart Failure: WATCHful Wondering
Circulation,
March 31, 2009;
119(12):
1559 - 1561.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. M. Massie, J. F. Collins, S. E. Ammon, P. W. Armstrong, J. G.F. Cleland, M. Ezekowitz, S. M. Jafri, W. F. Krol, C. M. O'Connor, K. A. Schulman, et al.
Randomized Trial of Warfarin, Aspirin, and Clopidogrel in Patients With Chronic Heart Failure: The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) Trial
Circulation,
March 31, 2009;
119(12):
1616 - 1624.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. L. Ripley and E. Nutescu
Anticoagulation in patients with heart failure and normal sinus rhythm
Am. J. Health Syst. Pharm.,
January 15, 2009;
66(2):
134 - 141.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H.-C. Diener, H. Mattle, M. Böhm, and F. Ruschitzka
CHAPTER 15a The Heart and the Brain
ESC Textbook of Cardiovascular Medicine,
January 1, 2009;
2(1):
med-9780199566990-chapter - med-9780199566990-chapter.
[Abstract]
[Full Text]
|
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
October 7, 2008;
118(15):
e523 - e661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
e1 - e142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. de Boer and D. J. van Veldhuisen
Letter by de Boer and van Veldhuisen Regarding Article, "Risk of Thromboembolism in Heart Failure: An Analysis from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT)"
Circulation,
January 1, 2008;
117(1):
e7 - e7.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gheorghiade, G. Sopko, L. De Luca, E. J. Velazquez, J. D. Parker, P. F. Binkley, Z. Sadowski, K. S. Golba, D. L. Prior, J. L. Rouleau, et al.
Navigating the Crossroads of Coronary Artery Disease and Heart Failure
Circulation,
September 12, 2006;
114(11):
1202 - 1213.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Nair, B. Sealove, J. L. Halperin, G. Webber, and V. Fuster
Anticoagulation in patients with heart failure: who, when, and why?
Eur. Heart J. Suppl.,
September 1, 2006;
8(suppl_E):
E32 - E38.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
e1 - e148.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
598 - 675.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. V. Cokkinos, G. C. Haralabopoulos, J. B. Kostis, P. K. Toutouzas, and for the HELAS investigators
Efficacy of antithrombotic therapy in chronic heart failure: The HELAS study
Eur J Heart Fail,
June 1, 2006;
8(4):
428 - 432.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Endorsed by the European Society of Intensive Care, Authors/Task Force Members, M. S. Nieminen, M. Bohm, M. R. Cowie, H. Drexler, G. S. Filippatos, G. Jondeau, Y. Hasin, J. Lopez-Sendon, et al.
Executive summary of the guidelines on the diagnosis and treatment of acute heart failure: The Task Force on Acute Heart Failure of the European Society of Cardiology
Eur. Heart J.,
February 2, 2005;
26(4):
384 - 416.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. A. Harrington, R. C. Becker, M. Ezekowitz, T. W. Meade, C. M. O'Connor, D. A. Vorchheimer, and G. H. Guyatt
Antithrombotic Therapy for Coronary Artery Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Chest,
September 1, 2004;
126(3_suppl):
513S - 548S.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. N. Walsh and M. E. Tavel
Evaluation and Management of a Patient With Congestive Heart Failure
Chest,
August 1, 2003;
124(2):
728 - 731.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Echemann, F. Alla, S. Briancon, Y. Juilliere, J.M. Virion, P.M. Mertes, J.P. Villemot, F. Zannad, and EPICAL Investigators
Antithrombotic therapy is associated with better survival in patients with severe heart failure and left ventricular systolic dysfunction (EPICAL study)
Eur J Heart Fail,
October 1, 2002;
4(5):
647 - 654.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. Appelros, I. Nydevik, A. Seiger, and A. Terent
Predictors of Severe Stroke: Influence of Preexisting Dementia and Cardiac Disorders
Stroke,
October 1, 2002;
33(10):
2357 - 2362.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V.L. Serebruany, M.E. McKenzie, A.F. Meister, S.Y. Fuzaylov, P.A. Gurbel, D. Atar, W.A. Gattis, and C.M. O'Connor
Whole blood impedance aggregometry for the assessment of platelet function in patients with congestive heart failure (EPCOT Trial)
Eur J Heart Fail,
August 1, 2002;
4(4):
461 - 467.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.Y.H. Lip and C.R. Gibbs
Anticoagulation for heart failure in sinus rhythm: a Cochrane systematic review
QJM,
July 1, 2002;
95(7):
451 - 459.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G.Y.H. Lip and C.R. Gibbs
Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm: a Cochrane systematic review
QJM,
July 1, 2002;
95(7):
461 - 468.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F Zannad
Evidence-based drug therapy for chronic heart failure
Eur. Heart J. Suppl.,
April 1, 2002;
4(suppl_D):
D66 - D72.
[Abstract]
[PDF]
|
|
|
|
|
|
|
J. G F Cleland, J. John, J. Dhawan, and A. Clark
What is the optimal medical management of ischaemic heart failure?
Br. Med. Bull.,
October 1, 2001;
59(1):
135 - 158.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J.G.F. Cleland, K. Thygesen, B.F. Uretsky, P. Armstrong, J.D. Horowitz, B. Massie, M. Packer, P.A. Poole-Wilson, L. Ryden, and on behalf of the ATLAS investigators
Cardiovascular critical event pathways for the progression of heart failure; a report from the ATLAS study
Eur. Heart J.,
September 1, 2001;
22(17):
1601 - 1612.
[Abstract]
[PDF]
|
|
|
|
|
|
|
R. Isnard and M. Komajda
Thromboembolism in heart failure, old ideas and new challenges
Eur J Heart Fail,
June 1, 2001;
3(3):
265 - 269.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Gomberg-Maitland, D. A. Baran, and V. Fuster
Treatment of Congestive Heart Failure: Guidelines for the Primary Care Physician and the Heart Failure Specialist
Arch Intern Med,
February 12, 2001;
161(3):
342 - 352.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Cairns, P. Theroux, H. D. Lewis Jr., M. Ezekowitz, and T. W. Meade
Antithrombotic Agents in Coronary Artery Disease
Chest,
January 1, 2001;
119
(2009):
228S - 252S.
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Diet and E. Erdmann
Thromboembolism in heart failure: who should be treated?
Eur J Heart Fail,
December 1, 2000;
2(4):
355 - 363.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. E WIEGERS and M. S. J. SUTTON
When should ACE inhibitors or warfarin be discontinued after myocardial infarction?
Heart,
October 1, 2000;
84(4):
361 - 362.
[Full Text]
|
|
|
|
|
|
|
G. S. Francis
Heart failure
J. Am. Coll. Cardiol.,
April 1, 2000;
35(5_Suppl_B):
6B - 9B.
[PDF]
|
|
|
|
|
|
|
F. Diet and E. Erdmann
Significance of thromboembolism in heart failure
Eur J Heart Fail,
March 1, 2000;
2(1):
3 - 4.
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. D. Sharma, P. A. McCullough, E. F. Philbin, and W. D. Weaver
Left Ventricular Thrombus and Subsequent Thromboembolism in Patients With Severe Systolic Dysfunction
Chest,
February 1, 2000;
117(2):
314 - 320.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. M. Pullicino, J. L. Halperin, and J. L. P. Thompson
Stroke in patients with heart failure and reduced left ventricular ejection fraction
Neurology,
January 25, 2000;
54(2):
288 - 288.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. V. Cokkinos and P. K. Toutouzas
Antithrombotic therapy in heart failure: a randomized comparison of warfarin vs. aspirin (HELAS)
Eur J Heart Fail,
December 17, 1999;
1(4):
419 - 423.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D.J. van Veldhuisen, A. Charlesworth, H.J.G.M. Crijns, K.I. Lie, and J.R. Hampton
Differences in drug treatment of chronic heart failure between European countries
Eur. Heart J.,
May 1, 1999;
20(9):
666 - 672.
[Abstract]
[PDF]
|
|
|
|
|
|
|
G. S. Francis
Heart failure
J. Am. Coll. Cardiol.,
February 1, 1999;
33(2):
291 - 294.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Miura and D. D. Gutterman
Human Coronary Arteriolar Dilation to Arachidonic Acid Depends on Cytochrome P-450 Monooxygenase and Ca2+-Activated K+ Channels
Circ. Res.,
September 7, 1998;
83(5):
501 - 507.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Warfarin Improves Survival in LV Dysfunction
Journal Watch Cardiology,
April 30, 1998;
1998(430):
5 - 5.
[Full Text]
|
|
|
|
|
|
|
Warfarin Associated With Increased CHF Survival
Journal Watch (General),
March 31, 1998;
1998(331):
3 - 3.
[Full Text]
|
|
|
|
