Evidence Favoring the Use of Anticoagulants in the Hospital Phase of Acute Myocardial Infarction

作者：Thomas C. Chalmers, Raymond J. Matta, Harry Smith, Anne-Marie Kunzler · 发表于：New England Journal of Medicine · 年份：1977 · DOI：10.1056/nejm197711172972004 · 被引用次数：433 · 研究领域：Venous Thromboembolism Diagnosis and Management、Atrial Fibrillation Management and Outcomes、Antiplatelet Therapy and Cardiovascular Diseases

Since the last comprehensive review of anticoagulation in acute myocardial infarction four additional randomized control trials have been reported. The overwhelming majority of all trials favored anticoagulation. Rates of thromboembolism were higher in the control, and hemorrhagic complications in the anticoagulated group. Pooling of all randomized control trials gives mean case fatality rates of 19.6% for the control and 15.4% for the anticoagulated group, a relative reduction of 21% (P less than 0.05 or less than 0.001, depending on the analytic method). Five of six randomized control trials reported "no effect" because the difference favoring anticoagulation was not statistically significant. However, sample sizes in these "negative" papers were too small to protect against missing a 21% reduction in true case fatality rate due to anticoagulation (beta greater than 0.10). All patients who present no specific contraindication should receive anticoagulants during hospitalization for infarction.