Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomised trials
Why the study?
Does anticoagulant therapy reduce mortality and cardiovascular events in patients with suspected acute myocardial infarction?
Population
About 73,000 patients with suspected acute myocardial infarction across 26 randomized trials.
Comparison
Anticoagulant therapy. vs Control.
Design
Meta-analysis, randomised comparisons
Follow-up
average follow up of about 10 days
Authors
Discussion
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Implication
Does not justify routine heparin addition to aspirin in AMI due to bleeding excess despite marginal mortality benefit; reinforces aspirin monotherapy as standard.
Structured PICO
Does anticoagulant therapy reduce mortality and cardiovascular events in patients with suspected acute myocardial infarction?
P
Population
About 73,000 patients with suspected acute myocardial infarction across 26 randomized trials (5,000 patients in 21 trials without routine aspirin, and 68,000 patients in 6 trials with routine aspirin).
I
Intervention
Anticoagulant therapy (heparin alone, heparin plus oral anticoagulants, or intravenous/high-dose subcutaneous heparin added to aspirin).
C
Comparator
Control (no anticoagulant therapy, with or without aspirin depending on the trial).
O
Outcome
Death, reinfarction, stroke, pulmonary embolism, and major bleeds at an average follow-up of about 10 days.hard clinical
The routine addition of intravenous or subcutaneous heparin to aspirin in acute myocardial infarction is not justified due to minimal mortality benefit and increased major bleeding.
Cite This Study
Collins et al. (1996) studied this question.