"Selective" Versus "Routine" Use of Anticoagulants in Acute Myocardial Infarction

Although anticoagulant therapy has become an accepted form of treatment for acute myocardial infarction, there is still much disagreement, even among authorities, regarding the indications for its use. Wright¹has advanced persuasive arguments in defense of the recommendation that anticoagulants be employed in all cases in which no contraindications exist,2abut there is, nevertheless, a growing weight of opinion in favor of withholding these agents from patients who have had a clinically mild infarction. The statistical data presented by the committee on anticoagulants of the American Heart Association,²as well as that recorded from numerous other sources, indicate that anticoagulant drugs exert a markedly favorable influence on both the death rate and the thromboembolic complication rate in unselected groups. In spite of this convincing evidence, none of these studies have actually shown that clinically mild or low risk groups share in the over-all benefit derived from this