Aspirin vs. warfarin: USF cardiologist part of landmark heart failure study

USF Health cardiologist Dr. Arthur Labovitz was an investigator and co-author for a landmark clinical trial reported May 2 in the New England Journal of Medicine, showing that aspirin and warfarin are equally effective in heart failure patients with normal heart rhythm.

Dr. Labovitz, professor of medicine and vice chair of Cardiovascular Sciences at the Morsani College of Medicine and an acting director of the USF Health Heart Institute, joined USF last year from St. Louis University, a site for the Warfarin and Aspirin for Reduced Cardiac Ejection Fraction (WARCEF) study. He continues to be a member of the WARCEF Study Group executive committee.

Dr. Arthur Labovitz, cardiologist

Dr. Arthur Labovitz

Supported by the National Institutes of Health, the 10-year WARCEF trial is the largest double-blind comparison of aspirin and warfarin (Coumadin) for heart failure, following more than 2,300 patients at 168 study sites in 11 countries.

Patients with heart failure, or weakened heart muscle, have a greater risk for blood clots that can lead to fatal or disabling stroke. Aspirin prevents clotting and warfarin thins the blood.

WARCEF indicated that overall the combined risk of death, stroke and brain hemorrhage was not statistically different between the two groups – 7.47 percent per year for patients taking warfarin and 7.93 percent a year for those taking aspirin. A reduced risk of stroke with warfarin was offset by a risk of major bleeding.

While previous studies established that warfarin was superior to aspirin for preventing stroke in heart failure patients with atrial fibrillation (abnormal heart rhythm), Dr. Labovitz said WARCEF is the first to definitively address the question for the majority of heart failure patients who have normal heart rhythm.

The researchers concluded that choice between the two treatments should be based on individual patient needs.  Future publications from WARCEF, including age-stratified analysis of the earlier data, are expected to yield additional guidance.

“WARCEF will impact the practice of medicine substantially in terms of establishing whether certain heart failure patients with normal heart rhythm will need blood thinners,” Dr. Labovitz said. “It’s important to be at the forefront of these types of rigorous, large-scale studies.”

A Columbia University news release contributed to this article.