Anticoagulant significantly reduces risk of heart failure

Researchers at the University of California Medical School in San Diego have discovered that the use of anticoagulants in patients with worsening heart failure, coronary heart disease or irregular heartbeat was associated with a 17% reduction in the risk of thromboembolic events, such as a stroke and a heart attack.

The results of the COMMANDER heart failure trial were published in the April 2019 issue of JAMA Cardiology.

Heart failure, sometimes called congestive heart failure, occurs when the heart muscle does not pump blood effectively. Certain conditions that narrow the arteries, such as coronary artery disease or high blood pressure, progressively weaken or stiffen the heart, reducing its ability to fill and pump efficiently. The researchers say that these conditions increase the risk of patients for later problems.

"We found that 17% of patients with heart failure due to insufficient blood in the heart, coronary heart disease and normal sinus rhythm (l 39; heart's electrical impulse) are experiencing thromboembolic events. "It was more common than originally thought," said Barry Greenberg, MD, Distinguished Professor of Medicine at the Faculty of Medicine from the University of San Diego and director of the Advanced Heart Failure Treatment Program at the University of San Diego Cardiovascular Institute.

"Initially, we wanted to know if we could improve outcomes in patients after an episode of worsening heart failure with a low dose of blood thinning, which we found was that although this strategy was not not achieved this goal, it was associated with a reduced risk of significant clinical events due to thrombosis – stroke, heart attack and sudden death of cardiac origin. "

According to the Centers for Disease Control and Prevention, about 610,000 people die each year from heart disease in the United States, or one in four deaths in the country. Heart disease is the leading cause of death for both men and women.

The international randomized trial, COMMANDER HF, involved 5,022 patients after discharge from hospital or treatment at an outpatient clinic for worsening heart failure. Patients received 2.5 mg rivaroxaban (an anticoagulant marketed as Xarelto) orally twice daily or placebo in addition to their standard treatment.

"Although low-dose rivaroxaban increased the risk of bleeding, major bleeding, which was the primary endpoint of safety of the study, did not increase in significantly, "said Greenberg. "This is an important observation because there is currently no warrant for physicians to prescribe anticoagulants to this patient population."

The researchers said the next steps would include confirmation of the results of large-scale prospective clinical trials.