Pharmacological treatment during AMI and in secondary prevention: the scientific evidence

Table 9a. Oral anticoagulants. Effect on mortality.
STUDIES DRUG No. PATIENTS FOLLOW-UP VAR. P
After infarction
SIXTY PLUS (1980) [87] COUMARIN 878 2 YEARS -26% 0.017
SMITH (1990) [88] WARFARIN 1,241 37 MONTHS -24% 0.0267
ASPECT (1994) [5] NICOUMALONE 3,404 37 MONTHS -10% NS
   
META-ANALYSES No. STUDIES No. PATIENTS   VAR. P
After infarction
DEVINE (1992) [21] 6 4,344   -22% 0.003

 

ACC/AHA GUIDELINES

  • Class I:
    • for patients who can't take ASA or with atrial fibrillation or with left ventricular thrombus.
  • Class IIa:
    • for patients with extensive alteration of parietal kinesis or with paroxysmal atrial fibrillation.
  • Class IIb:
    • in patients with severe LV dysfunction with or without failure

ANMCO-SIC GUIDELINES

Recommended with extensive anterior AMI, severe left ventricular dilatation and/or severe EF reduction, left ventricular thrombosis, atrial fibrillation

 

Table 9b. Anticoagulants + ASA. Effect on mortality.
STUDIES DRUG No. PATIENTS FOLLOW-UP VAR. P
After infarction
CARS (1996) [17] WARFARIN (3mg, 1mg) +ASA 80mg vs ASA 160 mg 8.800 NR -- NS

NR: non reported

ACC/AHA GUIDELINES

  • Not advised

ANMCO-SIC CLINICAL GUIDELINES