ASA in CHF

Q: "Routine aspirin (ASA) therapy in patients with congestive heart failure (CHF) may not be beneficial and actually may be harmful." (select one)

A) True
B) False


Answer: A

There is strong literature available to suggest that ASA may not be of any benefit rather harmful in CHF patients. Some of the major trials in this regard including WASH, WATCH and WARCEF trials have been given in the reference section 1,2, 3. 

 Various explanations have been sought for this paradox. It might be due to the fact that ASA may attenuate some effects of angiotensin-converting enzyme (ACE) inhibitors. Also, ASA may interfere with the positive effects of beta-blockers in patients with HFrEF.

#cardiology


References:

1. Cleland JG, Findlay I, Jafri S, et al. The Warfarin/Aspirin Study in Heart failure (WASH): a randomized trial comparing antithrombotic strategies for patients with heart failure. Am Heart J 2004; 148:157. 

2. Massie BM, Collins JF, Ammon SE, et al. 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 2009; 119:1616. 

3. Homma S, Thompson JL, Pullicino PM, et al. Warfarin and aspirin in patients with heart failure and sinus rhythm. N Engl J Med 2012; 366:1859. 

4. Madelaire C, Gislason G, Kristensen SL, et al. Low-Dose Aspirin in Heart Failure Not Complicated by Atrial Fibrillation: A Nationwide Propensity-Matched Study. JACC Heart Fail 2018; 6:156.

5. Lindenfeld J, Robertson AD, Lowes BD, et al. Aspirin impairs reverse myocardial remodeling in patients with heart failure treated with beta-blockers. J Am Coll Cardiol 2001; 38:1950.