Anticoagulant therapy in coronary artery disease

Abstract

1. 1. The effectiveness of anticoagulants in the reduction of mortality and thromboembolic complications in the patient with acute cardiac infarction is substantiated by a majority of the clinical reports dealing with this treatment. Experience with 213 cases at the Presbyterian Hospital has been favorable and comparable to the results of the American Heart Association study, effecting an appreciable reduction both in mortality rate and thromboembolic complications. 2. 2. I subscribe to the program of employing anticoagulant therapy in all patients with acute cardiac infarction, regardless of classification according to the type of risk, provided there is no contraindication to their use. The selective use of anticoagulant therapy in “poor risk” patients only is advised by some authorities. This appears to be a matter for personal determination by each clinician. 3. 3. Chronic anticoagulation for months and years, following the initial acute infarction, may offer an improved prognosis with respect to preventing recurrent cardiac infarctions. This aspect, of therapy needs further documentation. 4. 4. In patients with recent onset or a sharp intensification of the degree of anginal pain, the prophylactic use of anticoagulants may delay or ward off the final occlusion of a narrowed vessel. This needs further evaluation and study. 5. 5. Patients with arteriosclerotic heart disease exhibiting embolism originating from intracardiac thrombi are protected from recurrent embolism by continuous anticoagulant therapy. Therapy is not necessarily continued for life, as is the case in individuals with rheumatic heart disease. Anticoagulant therapy for approximately six months may suffice. 6. 6. Several coumarin and indandione drugs are available for use, all equally effective and similarly fraught with comparable risk of bleeding. Each physician should become thoroughly familiar with one agent and acquire experience in its dosage and its behavior in patients. 7. 7. Vitamin K and vitamin K 1 are essential and effective antidotes for the coumarin and indandione drugs. Protamine is a promptly effective antidote for excessive heparin effect. The judicious use of these antidotal drugs will contribute to the safety of anticoagulant treatment.