Anticoagulant therapy in acute myocardial infarction.

In 265 patients of acute myocardial infarction (AMI) heparin followed by warfarin sodium was used routinely whenever there was no contraindication to the drug. Patients were followed up to 2 years with weekly estimation of prothrombin time. Another 265 patients of AMI having identical clinical profiles were taken as control and neither any anticoagulant nor any antiplatelet agent was used in them. Both groups were also treated with identical coronary dilators whenever needed. 2 years cardiac mortality was 11.6% in the control group and 5.9% in the anticoagulant therapy (ACT) recipient group (P less than 0.05). Incidence of reinfarction (RMI) was 14.4% during the period in the control group whereas it was only 6.7% in the ACT group (P less than 0.05). The incidence of intracranial events were also more frequent in control group (8.4%) compared to ACT group (3.1%) (P less than 0.05). However on further analysis of intracranial events, it was found that haemorrhagic intracranial events were slightly more frequent in ACT (2.3%) than in the control group (2%), but this difference was statistically insignificant (P greater than 0.05); non-haemorrhagic intracranial events were however significantly less in ACT group (1.96%) compared to the control group (6%) (P less than 0.05). There was no major or fatal extracranial haemorrhagic complication in either group. Only minor extracranial haemorrhages were more commonly observed in the ACT group (4.3%) compared to the control group (1.2%) (P less than 0.05).