Abstract
OBJECTIVE--To investigate the efficacy of long term oral anticoagulant treatment in subgroups of patients after myocardial infarction. DESIGN--Analysis of the effect of anticoagulant treatment in subgroups of hospital survivors of myocardial infarction based upon age, gender, history of hypertension, previous myocardial infarction, smoking habits, diabetes mellitus, Killip class, anterior location of infarction, thrombolytic therapy, and use of beta blockers. SUBJECTS--Participants of a multicentre, randomised, double blind, placebo controlled trial that assessed the effect of oral anticoagulant treatment on mortality as well as cerebrovascular and cardiovascular morbidity in 3404 hospital survivors of acute myocardial infarction. MAIN OUTCOME MEASURES--The effect of anticoagulant treatment on recurrent myocardial infarction, cerebrovascular events, and vascular events (the composite endpoint of reinfarction, cerebrovascular event, and vascular death). RESULTS--Long term anticoagulant treatment was associated with a reduction in mortality of 10% (95% confidence interval -11% to 27%), recurrent myocardial infarction of 53% (41% to 62%), cerebrovascular events of 40% (10% to 60%) and vascular events of 35% (24% to 45%). Treatment effect with respect to recurrent myocardial infarction was comparable among all subgroups of patients. Although treatment effect appeared to be somewhat smaller in females than in males (-11% v -45%), and in patients with diabetes compared to those without (-14% v -42%) with respect to vascular events, none of these differences reached statistical significance. In multivariate analysis, more advanced age, previous myocardial infarction, diabetes mellitus, and heart failure during admission were independently associated with increased incidence of cardiovascular complications. CONCLUSIONS--The relative benefit of long term anticoagulant therapy in survivors of myocardial infarction is not modified by known prognostic factors for cardiovascular disease.
Full text
PDF




Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Fogelholm R., Eskola K., Kiminkinen T., Kunnamo I. Anticoagulant treatment as a risk factor for primary intracerebral haemorrhage. J Neurol Neurosurg Psychiatry. 1992 Dec;55(12):1121–1124. doi: 10.1136/jnnp.55.12.1121. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Geltman E. M., Ehsani A. A., Campbell M. K., Schechtman K., Roberts R., Sobel B. E. The influence of location and extent of myocardial infarction on long-term ventricular dysrhythmia and mortality. Circulation. 1979 Oct;60(4):805–814. doi: 10.1161/01.cir.60.4.805. [DOI] [PubMed] [Google Scholar]
- Martin C. A., Thompson P. L., Armstrong B. K., Hobbs M. S., de Klerk N. Long-term prognosis after recovery from myocardial infarction: a nine year follow-up of the Perth Coronary Register. Circulation. 1983 Nov;68(5):961–969. doi: 10.1161/01.cir.68.5.961. [DOI] [PubMed] [Google Scholar]
- Merrilees M. A., Scott P. J., Norris R. M. Prognosis after myocardial infarction: results of 15 year follow up. Br Med J (Clin Res Ed) 1984 Feb 4;288(6414):356–359. doi: 10.1136/bmj.288.6414.356. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Norris R. M., Caughey D. E., Mercer C. J., Scott P. J. Prognosis after myocardial infarction. Six-year follow-up. Br Heart J. 1974 Aug;36(8):786–790. doi: 10.1136/hrt.36.8.786. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smith P., Arnesen H., Abdelnoor M. Effects of long-term anticoagulant therapy in subgroups after acute myocardial infarction. Arch Intern Med. 1992 May;152(5):993–997. [PubMed] [Google Scholar]
- Smith P., Arnesen H., Holme I. The effect of warfarin on mortality and reinfarction after myocardial infarction. N Engl J Med. 1990 Jul 19;323(3):147–152. doi: 10.1056/NEJM199007193230302. [DOI] [PubMed] [Google Scholar]
- Stone P. H., Raabe D. S., Jaffe A. S., Gustafson N., Muller J. E., Turi Z. G., Rutherford J. D., Poole W. K., Passamani E., Willerson J. T. Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location. J Am Coll Cardiol. 1988 Mar;11(3):453–463. doi: 10.1016/0735-1097(88)91517-3. [DOI] [PubMed] [Google Scholar]
- Wintzen A. R., de Jonge H., Loeliger E. A., Bots G. T. The risk of intracerebral hemorrhage during oral anticoagulant treatment: a population study. Ann Neurol. 1984 Nov;16(5):553–558. doi: 10.1002/ana.410160505. [DOI] [PubMed] [Google Scholar]