Retrospective Evidence Favoring Use of Anticoagulants for Myocardial Infarctions

During a state-wide retrospective survey of myocardial infarction discharges from Maryland hospitals from July, 1966, through June, 1967, the relation of in-hospital case fatality rates to use of anticoagulants was examined in 1,156 patients. In patients who did not receive anticoagulants, the rate was 2.5 times that of those who did (p < 0.0001). A large difference in case fatality rates between the anticoagulant and no-anticoagulant groups persisted when the data were analyzed by demographic and medical-care variables. When patients were classified according to clinical characteristics relating to prognosis, including arrhythmia, congestive heart failure and shock, the difference between the groups was also demonstrated. Although such a retrospective study cannot demonstrate conclusively the value of anticoagulant therapy, the data are sufficiently suggestive of a beneficial effect to warrant reopening the anticoagulant question. (N Engl J Med 292:1362–1366, 1975), THE enthusiasm that accompanied the introduction of anticoagulants for patients with acute myocardial infarctions has cooled considerably during the past decade. Much of present opinion can be summed up in a statement made in a review article by Gross et al., in 1972: “Enough evidence in both clinical and pathologic observations has been adduced that shows that these drugs are probably of no value.”¹ Although some authors use anticoagulants for myocardial infarctions during the period of hospitalization, their rationale is a possible reduction in thromboembolic phenomena rather than a conviction that the agents will have any effect on case fatality.