Anticoagulant Therapy in Acute Myocardial Infarction

In 1948 the American Heart Association officially endorsed anticoagulation for patients sustaining an acute myocardial infarction. Its large cooperative, randomized, clinical trial was criticized because the randomization was not blind, and a possible bias was suggested by the enthusiasm of the cooperating investigators. Subsequent studies have not always supported the findings of that trial, and there is now a massive literature on the debate over the efficacy of this treatment in the acute infarct. Despite continuing arguments pro and con, the substantial proportion of physicians who accept the evidence in favor of coumarin derivatives has continued to pursue that therapy during the years so that in most of the large medical centers of this country it is possible to examine the results of their use in a large number of patients with myocardial infarction. This has been done in the report by Szklo et al in this issue ofThe