Is aspirin safe for patients with heart failure?

Cleland, John G.F.; Bulpitt, C. J.; Falk, R. H.; Findlay, Iain; Oakley, Celia M.; Murray, Gordon D.; Poole‐Wilson, Philip A.; Prentice, C. R. M.; Sutton, George C.

doi:10.1136/hrt.74.3.215

Cited by 137 publications

(85 citation statements)

References 44 publications

(7 reference statements)

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“…Trends to an increase in ~udden cardiac death with the administration of aspirin were a feature of the longtenn post-infarction studies (Table 1) comparing aspirin and placebo [26,27], although observational, and therefore flawed, data suggest the reverse among patients with chronic heart failure [28]. Not one of the long-term, post-infarction studies showed a reduction in mortality wi.th aspirin ~26>2().…”

mentioning

confidence: 99%

Sudden death in heart failure: vascular or electrical?

Cleland

Massie

Packer

1999

European J of Heart Fail

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mentioning

confidence: 99%

Sudden death in heart failure: vascular or electrical?

Cleland

Massie

Packer

1999

European J of Heart Fail

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“…This is also the smallest dose ever used in any of the substantial, long-term post-infarction studies [9]. Recent data has suggested that low-dose « 100 mg/day) aspirin may be less effective than higher doses [20].…”

Section: Dose Of Randomised Therapiesmentioning

confidence: 99%

“…Aspirin may be the simplest treatment to administer but the long-term efficacy of aspirin in· preventing vascular events has been called into question [5,9]. Observational data have suggested that aspirin may reduce the risk of sudden and all-cause mortality in heart failure [5,10,11].…”

Section: Introductionmentioning

confidence: 99%

“…However, patients with post-infarction heart failure randomised to aspirin have tended to have a higher mortality than patients randomised to placebo in long-term trials [5]. Sudden cardiac death rates have consistently tended to be higher on aspirin in long-term post-infarction studies suggesting that aspirin may reduce the rate of nonfatal events by increasing fatal ones [9]. Recent studies in hypertension also suggest that aspirin may reduce the risk of overt non-fatal myocardial infarction but increase the risk of covert, 'silent' infarcts [12].…”

Section: Introductionmentioning

confidence: 99%

“…More controversially, an adverse interaction with the effects of ACE inhibitors has been suggested [11]. Aspirin use is also associated with serious, but poorly quantified, gastro-intestinal toxicity [9].…”

Section: Introductionmentioning

confidence: 99%

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The WASH study (Warfarin/Aspirin Study in Heart failure) rationale, design and end‐points

Wash

1999

European J of Heart Fail

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Background: Athero-thrombotic events are common among patients with heart failure but there is no evidence that anti-thrombotic therapy is safe or effective in this clinical setting. Aims and Methods: The WASH study is a prospective, randomised, open-label, blinded-end-point pilot study comparing the outcome of management without anti-thrombotic therapy compared to treatment with aspirin or warfarin in three parallel arms in patients with chronic heart failure due to left ventricular systolic dysfunction. The primary aim of the study is to assess the feasibility of conducting a large study in which one-third of patients would be randomised to no anti-thrombotic therapy. The principal secondary aim of the study is to compare the effects of treatment on the combined end-point of death, non-fatal myocardial infarction and non-fatal stroke. Results: 279 patients have been randomised and by study close there wl~re 626 patient-years of follow-up. The majority of patients randomised had heart failure secondary to coronary artery disease. We expect to commence data analysis in early 1999 and report later in that year. Conclusions: This pilot study demonstrated that it is technically feasible to conduct a study that included a no anti-thrombotic treatment arm but that recruitment to such a study would be slow and costly. A large trial comparing the effects of aspirin, warfarin and clopidogrel in three separatl~ groups without a placebo arm is now intended.

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Does Aspirin Attenuate the Beneficial Effects of Angiotensin-Converting Enzyme Inhibition in Heart Failure?

Styŝ

Lawson²,

Smaldone³

et al. 2000

Arch Intern Med

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Ischemic heart disease is the most common underlying cause of congestive heart failure, and thus aspirin (acetylsalicylic acid [ASA]) and angiotensin-converting enzyme (ACE) inhibitors are commonly used together for treatment in this setting. The issue of possible attenuation of the effect of ACE inhibitors by ASA has been an area of intense debate. Currently, it is perceived that a significant part of the beneficial effect of ACE inhibitors is related to augmentation of bradykinin levels, which among other effects stimulate the release of prostacyclin. Aspirin, on the other hand, inhibits the production of prostacyclin by blocking cyclooxygenase. Prostaglandins play an important endogenous vasodilatory role and counteract the enhanced peripheral vasoconstriction state in congestive heart failure. Thus, the counteracting effect of ASA on the augmentation of prostacyclin synthesis by ACE inhibitors could result in a potential reduction of the beneficial effects of the ACE inhibitor's and could be of great importance. This article reviews reports from large clinical trials pertaining to this issue and relates their findings to the currently available theoretical bases for support of the counteracting effect of ASA on augmentation of prostacyclin synthesis by ACE inhibitors. The clinical implications of such an interaction are discussed.

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Is aspirin safe for patients with heart failure?

Cited by 137 publications

References 44 publications

Sudden death in heart failure: vascular or electrical?

Sudden death in heart failure: vascular or electrical?

The WASH study (Warfarin/Aspirin Study in Heart failure) rationale, design and end‐points

Does Aspirin Attenuate the Beneficial Effects of Angiotensin-Converting Enzyme Inhibition in Heart Failure?

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