PMID: 2483237Jan 1, 1989Paper

Blood clotting active drugs in long-term post-myocardial infarction treatment.

Journal of Cardiovascular Pharmacology
G G Neri SerneriF Bonechi

Abstract

Oral anticoagulants have been used for over three decades in long-term post-myocardial infarction treatment. The cumulated results of the early clinical trials showed a reduction of general mortality of 20%. The reduction reached 60% when trials with adequate anti-coagulant treatment were considered. The most recent study (Sixty Plus Study 1980), a very well designed and conducted study with optimal anticoagulant dosage, reported a 2-year reduction in total mortality of 43% (p less than 0.017 vs. controls) and a reduction of reinfarction of 64.1% (p less than 0.0002). However, the incidence of major hemorrhagic episodes (27 vs. 3) and of definite intracranial hemorrhages (8 vs. 1) was very high in the treatment group with 6 deaths vs. 1 due to hemorrhage. An alternative way for controlling blood clotting activation and thrombin generation appears to be low-dose heparin treatment. In a randomized controlled clinical trial heparin administered in low doses (12,500 i.u. daily by subcutaneous route) reduced the reinfarction rate by 63% (p less than 0.05 vs. controls) and general mortality by 47% (p less than 0.05) over 2 years. Even the frequency of the fatalities attributable to thromboembolic events was significantly decreased. N...Continue Reading

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