Anticoagulants in Acute Myocardial Infarction

Anticoagulants in the treatment and prevention of acute myocardial infarction were initially advocated for three potential therapeutic benefits: lowering case fatality rate by limitation of infarct size, prevention of recurrent infarction, and reduction of thromboembolic complications.1 Despite early enthusiasm for their use, anticoagulants are now rarely employed in the in-hospital phase of management of patients with acute myocardial infarction.2 A recent survey of the Section on Clinical Cardiology of the American College of Chest Physicians3 revealed that fewer than 10 percent of respondents used warfarin routinely, and 65 percent rarely administered warfarin during hospitalization for acute myocardial infarction. Of those who did use warfarin, there was a clear association with the age of the physician. Only two percent of physicians under the age of 40 used warfarin routinely, whereas 25 percent of physicians over 60 favored its administration. The reasons for the striking repudiation of anticoagulant therapy relate primarily to mistrust of earlier insistence on its benefits, and apprehension over its risks. Nevertheless, recent consensus statements and editorial opinions reemphasize that there is a clear-cut role for anticoagulants in the management of acute myocardial infarction: reduction of the incidence of systemic embolization in those selectively at risk.