The Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial randomized patients with heart failure, reduced left ventricular systolic function, and sinus rhythm to warfarin, clopidogrel, or aspirin. The study was terminated early because of slow enrollment. There was no difference in the composite primary end point of death, nonfatal MI, or nonfatal stroke, but warfarin was associated with fewer nonfatal strokes than aspirin or clopidogrel.455 The Warfarin Versus Aspirin in Reduced Cardiac Ejection Fraction (WARCEF) trial randomized 2305 patients with reduced left ventricular ejection fraction and sinus rhythm to warfarin or aspirin and followed them up for up to 6 years.457 There was no difference in the primary composite outcome of ischemic stroke, ICH, or death resulting from any cause (HR, 0.93; 95% CI, 0.79 1.10), but there was a significant reduction in the rate of ischemic stroke with warfarin compared with aspi- rin (0.72 versus 1.36 events per 100 patient-years; HR, 0.52; 95% CI, 0.33 0.82). The rate of major hemorrhage, however, was greater in the warfarin than in the aspirin group. 