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

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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.

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References

  1. Sytkowski PA, Kannel WB, D’Agostino RB (1990) Changes in risk factors and the decline in mortality from cardiovascular disease. The Framingham Heart Study. N Engl J Med 322:1635–1641

    Article  PubMed  CAS  Google Scholar 

  2. Ghali JK, Cooper R, Ford E (1990) Trends in hospitalization rates for heart failure in the United States, 1973–1986. Evidence for increasing population prevalence. Arch Intern Med 150:769–773

    Article  PubMed  CAS  Google Scholar 

  3. Gheorghiade M, Bonow RO (1998) Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 97:282–289

    Article  PubMed  CAS  Google Scholar 

  4. McCullough PA, Philbin EF, Spertus JA, Kaatz S, Sandberg KR, Weaver WD, Resource Utilization Among Congestive Heart Failure (REACH) Study (2002) Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study. J Am Coll Cardiol 39:60–69

    Article  PubMed  Google Scholar 

  5. Felker GM, Shaw LK, O’Connor CM (2002) A standardized definition of ischemic cardiomyopathy for use in clinical research. J Am Coll Cardiol 39:210–218

    Article  PubMed  Google Scholar 

  6. Miller LW, Missov ED (2001) Epidemiology of heart failure. Cardiol Clin 19:547–555

    Article  PubMed  CAS  Google Scholar 

  7. Levy WC, Mozaffarian D, Linker DT, Sutradhar SC, Anker SD, Cropp AB, Anand I, Maggioni A, Burton P, Sullivan MD, Pitt B, Poole-Wilson PA, Mann DL, Packer M (2006) The Seattle Heart Failure Model: prediction of survival in heart failure. Circulation 113:1424–1433

    Article  PubMed  Google Scholar 

  8. Stewart S, Jenkins A, Buchan S, McGuire A, Capewell S, McMurray JJ (2002) The current cost of heart failure to the National Health Service in the UK. Eur J Heart Fail 4:361–371

    Article  PubMed  Google Scholar 

  9. O’Connor CM, Abraham WT, Albert NM, Clare R, Gattis Stough W, Gheorghiade M, Greenberg BH, Yancy CW, Young JB, Fonarow GC (2008) Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF). Am Heart J 156:662–673

    Article  PubMed  Google Scholar 

  10. Sbarouni E, Bradshaw A, Andreotti F, Tuddenham E, Oakley CM, Cleland JG (1994) Relationship between hemostatic abnormalities and neuroendocrine activity in heart failure. Am Heart J 127:607–612

    Article  PubMed  CAS  Google Scholar 

  11. Gibbs CR, Blann AD, Watson RD, Lip GY (2001) Abnormalities of hemorheological, endothelial, and platelet function in patients with chronic heart failure in sinus rhythm: effects of angiotensin-converting enzyme inhibitor and beta-blocker therapy. Circulation 103:1746–1751

    Article  PubMed  CAS  Google Scholar 

  12. Nixon JV (1983) Left ventricular mural thrombus. Arch Intern Med 143:1567–1571

    Article  PubMed  CAS  Google Scholar 

  13. Efremidis M, Pappas L, Sideris A, Filippatos G (2008) Management of atrial fibrillation in patients with heart failure. J Card Fail 14:232–237

    Article  PubMed  Google Scholar 

  14. Cleland JG (1997) Anticoagulant antiplatelet therapy in heart failure. Curr Opin Cardiol 12:276–287

    Article  PubMed  CAS  Google Scholar 

  15. Loh E, Sutton MS, Wun CC, Rouleau JL, Flaker GC, Gottlieb SS, Lamas GA, Moyé LA, Goldhaber SZ, Pfeffer MA (1997) Ventricular dysfunction and the risk of stroke after myocardial infarction. N Engl J Med 336:251–257

    Article  PubMed  CAS  Google Scholar 

  16. Lip GY, Gibbs CR (1999) Does heart failure confer a hypercoagulable state? Virchow’s triad revisited. J Am Coll Cardiol 33:1424–1426

    Article  PubMed  CAS  Google Scholar 

  17. Lip GY, Gibbs CR (2002) Antiplatelet agents versus control or anticoagulation for heart failure in sinus rhythm: a Cochrane systematic review. QJM 95:461–468

    Article  PubMed  CAS  Google Scholar 

  18. Subramaniam V, Davis RC, Shantsila E, Lip GY (2009) Antithrombotic therapy for heart failure in sinus rhythm. Fundam Clin Pharmacol 23:705–717

    Article  PubMed  CAS  Google Scholar 

  19. Mehta J, Mehta P, Platelet function studies in heart disease (1979) Enhanced platelet aggregate formation activity in congestive heart failure: inhibition by sodium nitroprusside. Circulation 60:497–503

    Article  PubMed  CAS  Google Scholar 

  20. Andreassen AK, Nordøy I, Simonsen S, Ueland T, Müller F, Frøland SS, Gullestad L, Aukrust P (1998) Levels of circulating adhesion molecules in congestive heart failure and after heart transplantation. Am J Cardiol 81:604–608

    Article  PubMed  CAS  Google Scholar 

  21. Devaux B, Scholz D, Hirche A, Klövekorn WP, Schaper J (1997) Upregulation of cell adhesion molecules and the presence of low grade inflammation in human chronic heart failure. Eur Heart J 18:470–479

    Article  PubMed  CAS  Google Scholar 

  22. Elkayam U, Cohen G, Gogia H, Mehra A, Johnson JV, Chandraratna PA (1996) Renal vasodilatory effect of endothelial stimulation in patients with chronic congestive heart failure. J Am Coll Cardiol 28:176–182

    Article  PubMed  CAS  Google Scholar 

  23. Levine TB, Levine AB (1990) Regional blood flow supply, demand in heart failure. Am Heart J 120:1547–1551

    Article  PubMed  CAS  Google Scholar 

  24. Massie BM, Collins JF, Ammon SE, Armstrong PW, Cleland JG, Ezekowitz M, Jafri SM, Krol WF, O’Connor CM, Schulman KA, Teo K, Warren SR, WATCH Trial Investigators (2009) Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial. Circulation 119:1616–1624

    Article  PubMed  CAS  Google Scholar 

  25. Cleland JG, Findlay I, Jafri S, Sutton G, Falk R, Bulpitt C, Prentice C, Ford I, Trainer A, Poole-Wilson PA (2004) The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J 148:157–164

    Article  PubMed  CAS  Google Scholar 

  26. Al-Khadra AS, Salem DN, Rand WM, Udelson JE, Smith JJ, Konstam MA (1998) Antiplatelet agents and survival: a cohort analysis from the Studies of Left Ventricular Dysfunction (SOLVD) trial. J Am Coll Cardiol 31:419–425

    Article  PubMed  CAS  Google Scholar 

  27. Jhund PS, Davie AP, McMurray JJ (2001) Aspirin inhibits the acute venodilator response to furosemide in patients with chronic heart failure. J Am Coll Cardiol 37:1234–1238

    Article  PubMed  CAS  Google Scholar 

  28. Savi P, Labouret C, Delesque N, Guette F, Lupker J, Herbert JM (2001) P2y(12), a new platelet ADP receptor, target of clopidogrel. Biochem Biophys Res Commun 283:379–383

    Article  PubMed  CAS  Google Scholar 

  29. Herbert JM, Bernat A, Maffrand JP (1993) Aprotinin reduces clopidogrel-induced prolongation of the bleeding time in the rat. Thromb Res 71:433–441

    Article  PubMed  CAS  Google Scholar 

  30. Herbert JM, Tissinier A, Defreyn G, Maffrand JP (1993) Inhibitory effect of clopidogrel on platelet adhesion and intimal proliferation after arterial injury in rabbits. Arterioscler Thromb 13:1171–1179

    Article  PubMed  CAS  Google Scholar 

  31. Herbert JM, Bernat A, Maffrand JP (1992) Importance of platelets in experimental venous thrombosis in the rat. Blood 80:2281–2286

    PubMed  CAS  Google Scholar 

  32. Yao SK, Ober JC, Ferguson JJ, Maffrand JP, Anderson HV, Buja LM, Willerson JT (1994) Clopidogrel is more effective than aspirin as adjuvant treatment to prevent reocclusion after thrombolysis. Am J Physiol 267:488–493

    Google Scholar 

  33. Awidi A, Saleh A, Dweik M, Kailani B, Abu-Fara M, Nabulsi R, Bener A (2010) Measurement of platelet reactivity of patients with cardiovascular disease on-treatment with acetyl salicylic acid: a prospective study. Heart Vessels. doi:10.1007/s00380-010-0086-0

  34. Serebruany VL, Malinin AI, Jerome SD, Lowry DR, Morgan AW, Sane DC, Tanguay JF, Steinhubl SR, O’Connor CM (2003) Effects of clopidogrel and aspirin combination versus aspirin alone on platelet aggregation and major receptor expression in patients with heart failure: the Plavix Use for Treatment of Congestive Heart Failure (PLUTO-CHF) trial. Am Heart J 146:713–720

    Google Scholar 

  35. Subramaniam V, Davis RC, Shantsila E, Lip GY (2009) Antithrombotic therapy for heart failure in sinus rhythm. Fundam Clin Pharmacol 23:705–717

    Article  PubMed  CAS  Google Scholar 

  36. Nguyen KN, Aursnes I, Kjekshus J (1997) Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II). Am J Cardiol 79:115–119

    Article  PubMed  CAS  Google Scholar 

  37. Malinin AI, O’Connor CM, Dzhanashvili AI, Sane DC, Serebruany VL (2003) Platelet activation in patients with congestive heart failure: do we have enough evidence to consider clopidogrel? Am Heart J 145:397–403

    Article  PubMed  CAS  Google Scholar 

  38. Peterson JG, Topol EJ, Sapp SK, Young JB, Lincoff AM, Lauer MS (2000) Evaluation of the effects of aspirin combined with angiotensin-converting enzyme inhibitors in patients with coronary artery disease. Am J Med 109:371–377

    Article  PubMed  CAS  Google Scholar 

  39. Leor J, Reicher-Reiss H, Goldbourt U, Boyko V, Gottlieb S, Battler A, Behar S (1999) Aspirin and mortality in patients treated with angiotensin-converting enzyme inhibitors: a cohort study of 11,575 patients with coronary artery disease. J Am Coll Cardiol 33:1920–1925

    Article  PubMed  CAS  Google Scholar 

  40. Dagenais GR, Pogue J, Fox K, Simoons ML, Yusuf S (2006) Angiotensin-converting-enzyme inhibitors in stable vascular disease without left ventricular systolic dysfunction or heart failure: a combined analysis of three trials. Lancet 368:581–588

    Article  PubMed  CAS  Google Scholar 

  41. Blais C Jr, Drapeau G, Raymond P, Lamontagne D, Gervais N, Venneman I, Adam A (1997) Contribution of angiotensin-converting enzyme to the cardiac metabolism of bradykinin: an interspecies study. Am J Physiol 273:2263–2271

    Google Scholar 

  42. Heesch CM, Crandall ME, Turbek JA (1996) Converting enzyme inhibitors cause pressure-independent resetting of baroreflex control of sympathetic outflow. Am J Physiol 270:728–737

    Google Scholar 

  43. Juhlin T, Jönsson BA, Höglund P (2008) Renal effects of aspirin are clearly dose-dependent and are of clinical importance from a dose of 160 mg. Eur J Heart Fail 10:892–898

    Article  PubMed  CAS  Google Scholar 

  44. Meune C, Mahé I, Solal AC, Lévy BI, Duboc D, Simoneau G, Champion K, Mourad JJ, Weber S, Bergmann JF (2006) Comparative effect of aspirin and clopidogrel on arterial function in CHF. Int J Cardiol 106:61–66

    Article  PubMed  Google Scholar 

  45. Kindsvater S, Leclerc K, Ward J (2003) Effects of coadministration of aspirin or clopidogrel on exercise testing in patients with heart failure receiving angiotensin-converting enzyme inhibitors. Am J Cardiol 91:1350–1352

    Article  PubMed  CAS  Google Scholar 

  46. Meune C, Wahbi K, Fulla Y, Cohen-Solal A, Duboc D, Mahé I, Simoneau G, Bergmann JF, Weber S, Mouly S (2007) Effects of aspirin and clopidogrel on plasma brain natriuretic peptide in patients with heart failure receiving ACE inhibitors. Eur J Heart Fail 9:197–201

    Article  PubMed  CAS  Google Scholar 

  47. Furuno T, Yamasaki F, Yokoyama T, Sato K, Sato T, Doi Y, Sugiura T (2011) Effects of various doses of aspirin on platelet activity and endothelial function. Heart Vessels 26:267–273

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Faculty of Medicine, Kocaeli University, Gümüşhane, Turkey

    Güliz Kozdağ, Mehmet Yaymacı, Umut Çelikyurt, Tayfun Şahin, Teoman Kılıç & Dilek Ural

  2. Department of Cardiology, Gümüşhane Government Hospital, Daltaban Semti Hasan Bey district, 29000, Gümüşhane, Turkey

    Gökhan Ertaş

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  1. Güliz Kozdağ
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  2. Mehmet Yaymacı
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  3. Gökhan Ertaş
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  4. Umut Çelikyurt
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Correspondence to Gökhan Ertaş.

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Kozdağ, G., Yaymacı, M., Ertaş, G. et al. Aspirin, clopidogrel, and warfarin use and outcomes in a cohort of 580 patients discharged after hospitalization for decompensated heart failure. Heart Vessels 27, 568–575 (2012). https://doi.org/10.1007/s00380-011-0185-6

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  • DOI: https://doi.org/10.1007/s00380-011-0185-6

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