Coronary Artery Insufficiency

Abstract

We do not possess any specific curative agent for coronary insufficiency. The vast complex of factors involved in the etiology and pathogenesis of thrombosing coronary atherosclerosis remains an enigma. The determining of therapeutic efficacy is extremely difficult. It is not surprising, therefore, that there is disagreement as to the effectiveness of anticoagulant therapy. I do think, however, that the main reason for this is that the type of patients treated has differed greatly and secondly, the quality of therapy has been far from uniform. The use of anticoagulants represents a prophylactic measure. It has its main indications in the early stages of the disease when thrombotic occlusion is a relatively frequent cause of death. Preferably, it should be given before extensive occlusions and irreversible myocardial damage have been done. By appropriate selection of such patients and by guiding therapy in such a way that an adequate and stable level of hypocoagulability is maintained, there is, in my opinion, convincing evidence of beneficial effect. This therapy has certain indications which by experience can be better classified and characterized than they are today. Anticoagulants have little, if any, place in the treatment of advanced coronary disease in which disability and mortality is to a great extent determined by non-thrombotic causes.