Selection of Patients for Anticoagulant Therapy in Acute Myocardial Infarction*

The Place of Anticoagulant Therapy in Acute Myocardial Infarction

“…Selection of cases . Among 1,318 patients in one of our recent studies, 611 (46 per cent) qualified as “good risks” (8). When the mild cases treated at home by conservative measures and the serious cases with specific contraindications to anticoagulant therapy are taken into account, probably not more than 30 per cent of all cases can be considered suitable for anticoagulant treatment.…”

“…Similar observations and conclusions have been recorded in the literature by an increasing number of authors. All studies of selected “good‐risk” cases of acute coronary occlusion published hitherto, including those of Wright et al ., clearly reveal that the death rate among such patients cannot be significantly altered by anticoagulants (6–8, 11, 14–16) (Table ). It is of interest that even among those who participated in the anticoagulant study sponsored by the American Heart Association, there are those who believe that anticoagulant therapy confers no benefit in clinically mild cases of acute myocardial infarction.…”

“…Thromboembolism . In 489 mild or “good risk” cases of acute coronary occlusion admitted to three New York hospitals (Table ), the death rate was 3.1 per cent; and if survival extended beyond the first two days of admission the recovery rate was 99 per cent (6–8). The death rate in this large segment of cases of coronary occlusion was less than that commonly recorded for pneumococcic pneumonia under modern antibiotic therapy.…”

“…The feasibility and justification of such classification at the onset of the attack or early in its course in order to determine the need for anticoagulant therapy, however, have been clearly demonstrated in a recent study in which we observed the clinical course and outcome in an additional 122 cases classified as “good risk” and treated by conservative measures without anticoagulants (8). In this series, at the first examination on admission to hospital, anticoagulant therapy was intentionally withheld in each instance because of the absence of the poor prognostic signs previously enumerated.…”