Long-term anticoagulant therapy in coronary atherosclerosis

Rebound after cessation of oral anticoagulant therapy: the biochemical evidence

“…Indeed, some authors have identified 'high-risk groups' with a strikingly high relapse rate which include patients who were on long-term anticoagulation for > 2 years (Keyes et al, 1956;Van Cleve, 1965;Kamath & Thorne, 1969), patients in whom anticoagulation was stopped because of bleeding (Sharland, 1966;Sise et al, 1961;Thomes et al, 1960), patients with advanced atherosclerosis in general (Kuhn et al, 1961) and more than one myocardial infarction in their history (Nichol et al, 1958;Van Cleve, 1966) or patients with angina in the month preceeding cessation (Michaels, 1970). Indeed, some authors have identified 'high-risk groups' with a strikingly high relapse rate which include patients who were on long-term anticoagulation for > 2 years (Keyes et al, 1956;Van Cleve, 1965;Kamath & Thorne, 1969), patients in whom anticoagulation was stopped because of bleeding (Sharland, 1966;Sise et al, 1961;Thomes et al, 1960), patients with advanced atherosclerosis in general (Kuhn et al, 1961) and more than one myocardial infarction in their history (Nichol et al, 1958;Van Cleve, 1966) or patients with angina in the month preceeding cessation (Michaels, 1970).…”

“…The interpretation is difficult because the prethrombotic state may simply reappear (and is not transient) after a phase of suppression by oral anticoagulants as suggested by one study (Harenberg et al, 1983), or the pathological vascular process has silently proceeded further and becomes overt again; both types of events are not consistent with a transient overshooting of coagulation and subsequent normalization but rather with a 'catching up' to the initial or actual levels (Michaels, 1970;Wright, 1960Wright, , 1961. Nevertheless, a potential rebound phase, as suggested by the data of Grip et al (1991), may represent a prethrombotic state which could become manifest only in the high-risk subgroups (Sharland, 1966;Nichol et al, 1958;Michaels, 1970;Van Cleve, 1965, thus requiring a large patient population for its documentation. It may be for these reasons that more recent clinical studies have failed to reach significance (Grip et al, 1991) or are anecdotal observations (Beer & Schlup, 1986).…”

“…The controversy over the presence or absence of a rebound phenomenon after cessation of oral anticoagulant therapy now extends over more than three decades (Marshall, 1963;Liebermann & Lindner, 1965;Dinon & Vander Veer, 1969;Kuhn et al, 1961;Evans & O'Rourke, 1970;Hart & Coull, 1983;Carter et al, 1958;Sharland, 1966;Sise et al, 1961;Thomas et al, 1960;Keyes et al, 1956;Nichol et al, 1958;Michaels & Beamish, 1967;Beer & Schlup, 1986;Grip et al, 1991;Michaels, 1970;Côté et al, 1977;Van Cleve, 1965Kamath & Thorne, 1969;Wright, 1960Wright, , 1961Pickering et al, 1964) and it is still unclear whether or not the phenomenon is real. Recent reports on rebound angina pectoris and rebound coagulation after cessation of heparin (Theroux et al, 1992) or of thrombin inhibitors (Gold et al, 1993;Willerson & Casscells, 1993) have again focused on the topic.…”

The Risk of Anticoagulation in Hemodialysis Patients

“…The risk of long-term anticoagulation has been evaluated in patients with myocardial infarction by several groups [1][2][3][4], The inci dence of hemorrhagic complications varied from one per 3.5 to one per 8 patient years. The incidence of serious complications requir ing blood transfusion or hospitalization ranged from one per 13 to one per 20 patient years.…”

A Five‐year Prognostic Study of Acute Myocardial Infarction

“…In an effort to increase the life span of patients who have survived an acute myocardial infarction, various drugs and surgical procedures have been advocated. Attempts are being made to improve the survival time by continuous long‐term anticoagulant therapy (1, 2), estrogenic substances (3, 4), heparin (5), diet (6), and surgery (7). As a control, long‐term studies of persons who survived a myocardial infarction but who did not subsequently receive any special type of therapy should have value.…”