© 2006 European Society of Cardiology
Efficacy of antithrombotic therapy in chronic heart failure: The HELAS study
a Cardiology Department, Hippokrateio Hospital, University of Athens Athens, Greece
b 1st Cardiology Department, Onassis Cardiac Surgery Center Athens, Greece
c UMDNJ-Robert Wood Johnson Medical School New Brunswick, USA
* Corresponding author. Cardiology Department, Hippokrateio Hospital, University of Athens, Athens, Greece.
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Abstract |
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Background: It is not clear if long-term antithrombotic treatment has a beneficial effect on the incidence of thromboembolism in chronic heart failure (CHF). The HELAS study (Heart failure Long-term Antithrombotic Study) is a multicentre, randomised, double-blind, placebo-controlled trial to evaluate antithrombotic treatment in patients with CHF.
Methods: 197 HF patients (EF <35%) were enrolled. Patients with Ischaemic Heart Disease were randomised to receive either aspirin 325 mg or warfarin. Patients with Dilated Cardiomyopathy (DCM) were randomised to receive either warfarin or placebo.
Results: Analysis of the data from 312 patient years showed an incidence of 2.2 embolic events per 100 patient years, with no significant difference between groups. The incidence of myocardial infarction, hospitalisation, exacerbation of heart failure, death and haemorrhage were not different between the groups. No peripheral or pulmonary emboli were reported. Echocardiographic follow-up for 2 years showed an overall increase in left ventricular ejection fraction from 28.2±6 to 30.3±7 p<0.05, which was most obvious in patients with DCM taking warfarin (EF 26.8±5.3 at baseline, 30.7±10 at 2 years, p<0.05).
Conclusions: (1) Overall embolic events are rare in heart failure regardless of treatment. (2) Treatment does not seem to affect outcome.
Key Words: Heart failure treatment • Aspirin • Anti-thrombotic treatment • Anticoagulants
Received December 22, 2004; Revised July 22, 2005; Accepted February 27, 2006
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