Written or medically reviewed by a board-certified physician. See About.com's Medical Review Policy.

Updated April 25, 2014.

Therapy with aspirin can lower a person’s risk of having cardiovascular events that are associated with blood clotting - in particular, myocardial infarction (heart attack) or stroke.  For instance, aspirin has been shown to significantly reduce cardiovascular risk in people with coronary artery disease (CAD) - especially those who have had acute coronary syndromes (including a prior heart attack), or angina, or angioplasty, stenting, or bypass surgery.

  In addition, aspirin therapy is recommended for many people whose risk for cardiac disease is significantly elevated.

• Read about assessing your risk for heart disease.
• Read about who should take prophylactic aspirin therapy.

Whether aspirin therapy should be used for patients who have heart failure, however, has proven to be a difficult question to answer, and in fact, the experts remain largely undecided on this question.  For the most part, aspirin is not recommended in the treatment of heart failure.  However, new evidence suggests that perhaps low-dose aspirin should be strongly considered in this condition.

Aspirin in Heart Failure

People who have heart failure are known to have an increased incidence of cardiovascular events caused by blood clotting, especially stroke.  Because aspirin improves outcomes in patients with other types of heart disease, it is reasonable to suspect that the same would hold true for patients with heart failure.  However, evidence that aspirin actually provides such a benefit in heart failure has been difficult to come by.

While several smaller studies have suggested a benefit with aspirin therapy, the largest clinical trials (the WASH trial, the WATCH trial, and the WARCEF trial) all failed to show any significant benefit with aspirin in patients with heart failure. (All three of these trials compared results with aspirin to results with Coumadin in these patients.  In general, Coumadin reduced the risk of stroke caused by blood clots, but increased the risk of strokes caused by bleeding, to the point that there was little or no overall benefit from the use of Coumadin.)

However, a newer study, published in early 2014, suggests that the question of aspirin therapy for heart failure has not yet been fully answered.  In a non-randomized study of 1476 patients being followed in a heart failure disease management program in Ireland, those who were prescribed very-low-dose aspirin therapy (75 mg per day) had a 42% reduction in mortality  over a 2-year follow-up period, compared to patients not receiving aspirin, or receiving higher-dose aspirin.

Notably, patients randomized to aspirin therapy in the WASH, WATCH and WARCEF trials all received higher-dose aspirin therapy.  So, perhaps aspirin therapy would indeed benefit patients with heart failure - but only at a lower dose than has most often been used in practice or in clinical trials. Before these new new results can be widely applied, however, new randomized clinical trials will be necessary to assess more precisely the effect of very-low-dose aspirin in heart failure.

In The Meantime

Today, most experts do not recommend the routine use of either aspirin or Coumadin in patients with heart failure, unless the patient also has either a known clot in the heart (a finding that is diagnosed with an echocardiogram), or a history of stroke caused by blood clotting, or significant CAD, or atrial fibrillation.

At the same time, many other doctors do recommend low-dose aspirin therapy for their patients with heart failure.  Based on results from the 2014 Irish study, these doctors might want to consider reducing the dose of aspirin in such patients to 75 mg per day.

<sub>Sources

Bermingham M, Shanahan MK, O'Connell E, et al. Aspirin use in heart failure: Is low-dose therapy associated with mortality and morbidity benefits in a large community population? Circ Heart Fail 2014; DOI:10.1161/CIRCHEARTFAILURE.113.000132.

Cleland JG, Findlay I, Jafri S, Sutton G, 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; 148:157-164.

Garg RK, Gheorghiade M, Jafri SM. Antiplatelet and anticoagulant therapy in the prevention of thromboemboli in chronic heart failure. Prog Cardiovasc Dis 1998 Nov-Dec; 41(3):225-36.

Diet F, Erdmann E. Thromboembolism in heart failure: who should be treated? Eur J Heart Fail 2000 Dec; 2(4):355-63.</sub>