Patient selection for anticoagulant therapy in coronary heart disease

Short-term anticoagulant therapy given after an acute myocardial infarction is directed toward preventing thromboembolism and is fairly safe. Long-term anticoagulant therapy prevents coronary thrombosis in selected patients with coronary heart disease (CHD), but carries an appreciable risk of hemorrhage. A decision for or against short-term therapy should be based on an assessment of the immediate risk of thromboembolism. Similarly, the risk of coronary thrombosis should be the major determinant in a decision for or against long-term anticoagulation. The most important information emerging from the clinical trials of long-term anticoagulant therapy in CHD concerns the significant benefit observed among patients with advanced disease.