Anticoagulants in the treatment of cardiac infarction

• Published in: The American heart journal Vol. 46; no. 6; pp. 865 - 882
• Main Author: Kerwin, A.J.
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.12.1953
• Subjects: Anticoagulants - therapeutic use; Humans; Infarction; Myocardial Infarction - therapy; Old Medline; ANTICOAGULANTS/therapeutic use; MYOCARDIAL INFARCT/therapy
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/0002-8703(53)90086-6

1. 1. Theoretical and experimental considerations suggest that the use of anticoagulants in cardiac infarction will result in a reduction in the frequency of thrombo-embolic complications and a decline in the mortality rate. The results in most reported series appear to indicate that this therapy is definitely of value; however, several authors dissent. They claim that the routine use of anticoagulants in all cases is unnecessary because of the slight over-all benefit obtained, the expense and the risk, and that they should be employed only where the patient is a “poor risk”. 2. 2. In this series 220 cases of cardiac infarction were treated with Dicumarol and 81 cases with Danilone, a total of 301 cases. The control series was made up of 160 cases, comparable in age and sex distribution. 3. 3. The mortality rate in the control series was 29.4 per cent and in the treated 17.9 per cent. The most marked difference was in patients over 60 years of age. The greatest reduction took place after the first week of therapy. 4. 4. Where previous evidence of coronary disease (angina and/or infarction) existed, the mortality in controls was 30.0 per cent and in treated 20.5 per cent. Where no such diagnosis had been made before, the mortality rates were 25.9 per cent and 15.7 per cent, respectively. The mortality rate in hypertensives was not affected by treatment, but in nonhypertensives it was 32.9 per cent in the controls and 14.2 per cent in the treated. Diabetic patients showed a much improved death rate with anticoagulants, but the number of cases available was small. 5. 5. In those patients who had no cardiac failure there was no difference in the death rate among treated and untreated patients. In the presence of failure, anticoagulant therapy was associated with a decrease in the death rate from 60.6 per cent (controls) to 33.3 per cent (treated). A similar reduction was evident in those cases who had both failure and previous coronary disease (60.0 per cent and 30.8 per cent, respectively). The deaths preceded by thromboembolic phenomena were fewer in the treated series (4.9 per cent) compared with the controls (11.9 per cent). 6. 6. Thrombo-embolic complications occurred in 20.0 per cent of the controls and in 7.6 per cent of those receiving anticoagulants. A similar marked reduction in the total number of such complications was noted. These differences were evident only in patients over 50 years of age and were marked mainly after the second week of treatment. 7. 7. In those treated with anticoagulants hemorrgagic complications, mostly in the urinary tract, occurred in 18.6 per cent. Bleeding was much less common with Danilone than with Dicumarol. No deaths due to hemorrhage occurred in the case included in this series.