Aspirin, clopidogrel, and warfarin use and outcomes in a cohort of 580 patients discharged after hospitalization for decompensated heart failure

Abstract

The benefits of taking of aspirin, clopidogrel, and warfarin in relation to cardiovascular mortality and re-hospitalization in chronic heart failure (HF) patients have been called into question. We examined the outcomes (cardiac mortality and/or HF re-hospitalization) in patients discharged from our hospital between January 2003 and July 2009 after hospitalization for chronic decompensated HF. Of 580 HF patients (mean age, 63 ± 13 years; mean ejection fraction, 26 ± 9%, 63% with coronary disease and 37% without coronary disease), 207 patients (36%) died due to cardiovascular reasons, and 313 (54%) required HF re-hospitalization for decompensated HF during a 39 ± 14 month follow-up period. 101 (17%) patients were taking clopidogrel during enrollment in the study. When comparing patients who were on clopidogrel treatment with those who were not, clopidogrel was found to have a beneficial effect on cardiac mortality (27 vs. 38%, P = 0.04). In conclusion, in this observational prospective study, patients who used clopidogrel showed decreased cardiac mortality [HR, 0.566 (95% CI 0.332-0.964), P = 0.036] compared to patients who did not take clopidogrel. Clopidogrel had a beneficial effect on the survival of chronic HF patients in the long term.

Influence of documented history of coronary artery disease on outcomes in patients admitted for worsening heart failure with reduced ejection fraction in the EVEREST trial

“…Furthermore, an observational study in HF patients with acute MI not undergoing PCI found that patients receiving CAD therapy with clopidogrel had reduced mortality compared with those not receiving clopidogrel (HR 0.86, 95% CI 0.78–0.95) . Similar findings have been observed in a small prospective study in patients with acute decompensated HF without MI . CAD therapies including antiplatelet agents may represent one strategy to improve outcomes in acute HF patients.…”

Is There a Rationale for Antiplatelet Therapy in Acute Heart Failure?

“…Another, smaller study of patients hospitalized for AHF showed lower mortality rates in patients taking clopidogrel, or aspirin plus clopidogrel versus a control group not receiving antiplatelet therapy. 61 Aspirin use alone was not associated with a difference in outcome. These findings support the hypothesis that platelet activation may play a key role in the poor prognosis of HF patients and suggest a possible therapeutic benefit with clopidogrel.…”

Role of Antiplatelet Therapy and Anticoagulation in Nonischemic Cardiomyopathy

“…51 However, these results are limited to a single center and warrant further study. Additionally, the use of other P2Y 12 inhibitors, such as ticlopidine, prasugrel, ticagrelor, and cangrelor, have not been explored as alternatives to aspirin or warfarin in a HF population for prevention of thrombotic events.…”