THE SELECTIVE USE OF ANTICOAGULANTS IN ACUTE MYOCARDIAL INFARCTION BASED ON INITIAL PROGNOSIS

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Abstract
The prognosis in 117 cases of verified acute myocardial infarction was recorded immediately, 24, and 48 hours after the onset of the attack. The examining physician changed his mind concerning the prognosis after the initial impression was recorded in 31 of the 107 (29.0%) that survived the first 48 hours. "Satisfactory risk" patients as judged at the end of 48 hours had a mortality of 5% with or without anticoagulants. The "poor risk" cases had a mortality of 25%. Previous myocardial infarction and heart disease were the most important features in the past history which indicated a "poor risk". The most ominus signs of the acute attack were severe shock and acute pulmonary edema. Absent QRS changes in the 12 lead ecg usually indicated a "satisfactory risk". The absence of mortality in the 26 cases admitted after the first 24 hours of the attack were surprising. It is almost impossible to determine the prognosis of acute myocardial infarction during the first 48 hours of the attack with enough accuracy to justify the withholding of anticoagulants. Consequently it is recommened that anticoagulants be given to all cases initially for at least 2 days until an accurate appraisal of the prognosis can be made. After that the anticoagulants may be discontinued in those judged to be in the "good risk" category.