Results of the Warfarin versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) Trial

Background: Patients with heart failure (HF) in sinus rhythm are at a high risk for death and a risk for stroke. Currently, there is not a preferred regimen with this population, which is prevalent in the U.S. Funded by NIH/NINDS.

Purpose: Determine which of 2 treatments, warfarin or ASA, in combination with standard HF regimen is better for preventing stroke and death in patients with reduced left ventricular ejection fraction (LVEF). Methods: International, multicenter, randomized, double-blind, controlled clinical trial comparing warfarin (target INR 2.75+-0.25) and ASA (325 mg/d). N=2305. Mean followup=3.5 years. Primary Endpoints: Combined endpoint: time to first event: death, ischemic stroke or intracerebral hemorrhage in patients w/ LVEF<35% and in sinus rhythm. Secondary Endpoints: Primary outcome plus MI and HF hospitalization Results: No difference for primary or secondary outcomes. At 4 yrs and beyond, warfarin suggested as beneficial for primary endpoints. Conclusion: For primary endpoint, no difference for warfarin compared to aspirin in patients with reduced LVEF in normal sinus rhythm.
2012, American Heart Association. All rights reserved.

Presented by: Shunichi Homma, NY, NY. Int.l Stroke Conference 2/3/12