Conservative Anticoagulant Therapy of Acute Myocardial Infarction

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Abstract
In this study depression of the Owren P and P test to 10-30% of normal was arbitrarily defined as "adequate" treatment. This is a fairly conservative level of anticoagulation and represents a Quick prothrombin time of 21-26 seconds with a normal control of 15 seconds (or 39-57% activity), and carries a very low hemorrhagic complication rate. In a random selection of 250 cases of acute myocardial infarction without severe concurrent disease, from a hospital series of 1,078 for the year 1959, three approximately equal groups of patients were found to have been a) adequately treated, b) inadequately treated, c) did not receive treatment with oral anticoagulants. In the group as a whole, adequate treatment appeared to reduce the mortality from 54 to 22%, which is in close agreement with previously reported studies. Taking into account the age of the patient, the severity of the attack and the grade of anticoagulant therapy, it was found that adequate treatment significantly reduced the mortality only of bad risk patients under 70 years. In good risk patients, adequate therapy appeared to give little direct benefit. However, an important feature of this group, was that a proportion, 13% in this series, were potentially bad risk patients. There is at present no fool-proof method of defining this proportion, and therefore, as the benefits of anticoagulant therapy are so striking in bad risk patients under 70, it would be wrong to run the risk of allowing a good risk patient to become an untreated bad risk patient.

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