Although the two treatments are equally effective, researchers from Columbia University in New York City said their findings could prompt more doctors and patients to choose aspirin because it is much cheaper.
The 10-year study was the largest comparison of aspirin and warfarin (Coumadin) in the treatment of heart failure patients. In conducting the comparison, researchers followed more than 2,300 patients in 11 countries on three continents. Study participants were assigned randomly either to aspirin or warfarin, and neither the patient nor their doctor knew which medication each patient was taking.
The investigators found that the combined risk of death, stroke and cerebral hemorrhage during the study period was 7.47 percent for patients taking warfarin and 7.93 percent for patients taking aspirin -- a difference that is statistically insignificant.
Although patients taking warfarin had a nearly 50 percent lower risk for stroke than those taking aspirin, their risk for major bleeding was twice as high. As a result, the researchers argued that the benefits do not outweigh the risks. They noted, however, that taking warfarin for four years or more may be more effective at preventing stroke and death.
"With at least 6 million Americans -- and many more around the world -- suffering from heart failure, the results of the ... study will have a large public health impact," Dr. Walter Koroshetz, deputy director of the U.S. National Institute of Neurological Disorders and Stroke, said in a Columbia University news release. "Patients and their physicians now have critical information to help select the optimum treatment approach. The key decision will be whether to accept the increased risk of stroke with aspirin or the increased risk of primarily gastrointestinal hemorrhage
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