Does long-term anticoagulant therapy reduce mortality in patients with coronary heart disease and myocardial infarction?
Long-term continuation of anticoagulant therapy in patients with myocardial infarction appears to reduce 5- and 10-year mortality compared to discontinuation or no treatment, despite an increased risk of non-fatal bleeding.
An attempt has been made to evaluate the effectiveness of continuing the administration of anticoagulants over a period of years in the treatment of coronary heart disease. In a series of 521 patients there was a group of 408 with myocardial infarction, within which it was possible to make comparisons between 268 patients who kept up the anticoagulant treatment and 140 (pseudocontrols) who discontinued such treatment after three months to 10 years. Mortalities at both the 5-year and 10-year epochs were higher for the pseudocontrols (29 and 36%) than for those who continued the treatment (21 and 25%). The 5-year and 10-year mortality figures in the series available in the literature in which anticoagulants were not given (true controls) are 44 and 68 % respectively. The conclusion that anticoagulant therapy improved the prognosis for the patient was corroborated by other comparisons within this series as well as comparisons with data published by other investigators. Anticoagulants in the dosages here used caused 58 minor and several rather severe hemorrhagic episodes but no fatalities.
Robert E. Ensor (Sat,) studied this question.