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Original research article
Anticoagulation therapy in heart failure and sinus rhythm: a systematic review and meta-analysis
  1. Simon A S Beggs1,
  2. Rasmus Rørth2,
  3. Roy S Gardner3,
  4. John J V McMurray1
  1. 1 BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
  2. 2 Cardiology, Rigshospitalet, Kobenhavn, Kbh Ø, Denmark
  3. 3 Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Clydebank, UK
  1. Correspondence to Professor John J V McMurray, British Heart Foundation Cardiovascular Research Centre, University of Glasgow, Glasgow, G12 8TA, UK; John.McMurray{at}


Objective Heart failure is a prothrombotic state, and it has been hypothesised that thrombosis and embolism cause non-fatal and fatal events in heart failure and reduced ejection fraction (HFrEF). We sought to determine the effect of anticoagulant therapy on clinical outcomes in patients with HFrEF who are in sinus rhythm.

Methods We conducted an updated systematic review and meta-analysis to examine the effect of anticoagulation therapy in patients with HFrEF in sinus rhythm. Our analysis compared patients randomised to anticoagulant therapy with those randomised to antiplatelet therapy, placebo or control, and examined the endpoints of all-cause mortality, (re)hospitalisation for worsening heart failure, non-fatal myocardial infarction, non-fatal stroke of any aetiology and major haemorrhage.

Results Five trials were identified that met the prespecified search criteria. Compared with control therapy, anticoagulant treatment did not reduce all-cause mortality (risk ratio [RR] 0.99, 95% CI 0.90 to 1.08), (re)hospitalisation for heart failure (RR 0.97, 95% CI 0.82 to 1.13) or non-fatal myocardial infarction (RR 0.92, 95% CI 0.75 to 1.13). Anticoagulation did reduce the rate of non-fatal stroke (RR 0.63, 95% CI 0.49 to 0.81, p=0.001), but this was offset by an increase in the incidence of major haemorrhage (RR 1.88, 95% CI 1.49 to 2.38, p=0.001).

Conclusions Our meta-analysis provides evidence to oppose the hypothesis that thrombosis or embolism plays an important role in the morbidity and mortality associated with HFrEF, with the exception of stroke-related morbidity.

  • heart failure
  • stroke

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  • Contributors The authors have reviewed and approved the submission of this manuscript. Specifically, SASB performed the analysis and drafted the manuscript. RR contributed to the analysis and reviewed the manuscript. RSG and JJVM reviewed and revised the manuscript. JJVM is responsible for the overall content as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement There are no available unpublished data from this study.

  • Author note This manuscript is original and is not under consideration for publication elsewhere.

  • Patient consent for publication Not required.