华法令是临床上常用的抗凝剂，其效果虽佳，但易并发出血等，故病友在服用该药时常需要定期检查出、凝血指标，以观察疗效和避免副作用。作为传统的解热镇痛药～阿斯匹林亦有抗凝血功效，那么它是否可以替代华法令以治疗窦性心律的慢性心力衰竭患者呢？

日前，美国哥伦比亚大学的研究人员报道的“一项为期10年，涉及3大洲11个国家，共2300名患者的研究结果提示，尽管服用华法令组之中风的风险较服用阿斯匹林者低（约低50%）），但出血（特别是胃肠道出血）的发生率则显著高于阿斯匹林组（约高出1倍）。”

这一结果充分说明“华法令虽然有更好的预防中风之效果，但使用时剂量较难把握，风险亦大；相反，阿斯匹林虽然预防中风的效果略差，但招致出血的风险较低，且价格便宜和便于掌握剂量，故更适合于经济收入较少的患者服用。

Aspirin as Effective as Warfarin for Heart Failure: Study

Doctors, patients may opt for cheaper, over-the-counter aspirin, researchers say

WEDNESDAY, May 2 (HealthDay News) -- Aspirin is just as effective as the blood-thinner warfarin in preventing stroke and death in heart failure patients with a normal heart rhythm, a landmark study indicates.

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 [stomach bleeding] with warfarin."

Although the study, published in the May 3 issue of the New England Journal of Medicine, found aspirin and warfarin to be equally effective, the researchers noted that aspirin may be a more likely choice for doctors and patients.

Like warfarin, aspirin reduces the risk of stroke due to a clot or blockage. Aspirin, however, is cheaper and available over the counter. Warfarin also requires a strict dosing regimen, including regular blood tests to monitor patients' clotting levels.

"Since the overall risks and benefits are similar for aspirin and warfarin, the patient and his or her doctor are free to choose the treatment that best meets their particular medical needs," principal investigator, Dr. Shunichi Homma, associate chief of the cardiology division at New York-Presbyterian/Columbia and a professor of medicine at Columbia's College of Physicians and Surgeons in New York City, said in the news release. "However, given the convenience and low cost of aspirin, many may go this route."

SOURCE: Columbia University, news release, May 2, 2012