Continuous Anticoagulant Therapy Following Myocardial Infarction

Abstract

In 1957 the value of continuous, long-term anticoagulant therapy for the prevention of myocardial infarction was reported.' The study was unique for several aspects: All patients were seen during an episode of acute myocardial infarction, confirmed clinically and electrocardiographically. Alternate patients received an oral anticoagulant and ascorbic acid (250 mg) and a control group received ascorbic acid (250 mg) as a placebo. In addition, a third group was included which consisted of patients who had refused to cooperate and to maintain a close follow-up in either of the above groups. Two groups of patients were followed for fifteen years. The third group was followed only for 10 years. Otherwise all three groups were treated in exactly the same manner and by the same physicians. The number of visits, and the frequency of blood prothrombin determinations performed (usually every two to four weeks) were exactly the same for both the patients on continuous anticoagulant therapy, as well as for those in the control group receiving ascorbic acid placebo. Only the patients who had refused treatment were seen less frequently and only when complications or symptoms had developed. This study was initiated 15 years ago, shortly after oral anticoagulant therapy was introduced. Continuous anticoagulant therapy was administered in order to determine whether it could ameliorate or alter the long-term prognosis of coronary atherosclerotic heart disease, and reduce the recurrence of myocardial infarction and mortality.The smaller third group, who were uncooperative and had refused either placebo or anticoagulant therapy, were nevertheless followed for a 10 year period. The present report provides the additional experience in the first two groups of

Secondary Prevention of Myocardial Infarction: a Comparison of Acetylsalicylic Acid, Placebo and Phenprocoumon

“…Although there is a large variation between positive and negative results (e.g. Macmillan et al, 1960;Kuhn et al, 1961;Harvald et al, 1962;Aspenstrom and Korsan-Bengtsen, 1964;Conrad et al, 1964;Ebert et al, 1969;Manchester, 1964;Seaman et al, 1969\Menwissen et al, 1969Loeliger et al, 1967;Ritland and Lyngren, 1969;Veterans Adminis tration Hospital investigators, 1965, a reduction in the recurrence of secondary myocardial infarction was observed more clearly than a reduction in total mor tality or coronary death. If total mortality or coronary death were reduced during anticoagulant treatment, this effect was usually most pronounced during the first year of treatment and less evident during the following years.…”