Phenprocoumon and Heparin After Myocardial Infarction

Although anticoagulants are used extensively in patients with ischemic heart disease, there is disagreement about their efficacy. The drugs used most commonly in long-term treatment in survivors of myocardial infarction are coumarins and indandiones; but heparin is also advocated, and in 1956 Engelberg, Kuhn, and Steinman reported that prolonged intermittent heparin therapy reduced the mortality rate when given to patients who had previously had a myocardial infarct. 1 In their study, patients were alternately placed in two groups. One group of 105 patients received twice-weekly subcutaneous injections of 200 mg concentrated aqueous heparin for an average of 19.7 months. The other group of 117 patients received subcutaneous isotonic saline placebo injections twice weekly for an average of 18.7 months. Over a period of therapy ranging from 1½-27 months there were four deaths due to cardiovascular disease in the heparin-treated group and 21 in the saline-treated group. This heparin regimen seemed