Orale anticoagulantia na een myocardinfarct: weinig effect op sterfte maar sterke vermindering van cardiale en cerebrovasculaire complicaties; een gerandomiseerd onderzoek

To establish the effect of protracted treatment with oral anticoagulants after a myocardial infarction on the mortality and the risk of bleeding.

Design

Multicentre prospective randomised double-blind study.

Setting

Sixty Dutch hospitals.

Method

Eligible myocardial infarction patients were randomly assigned to anticoagulant (acenocoumarol or phenprocoumon) or placebo treatment within 6 weeks of discharge. The target prothrombin time was 2.8-4.8 international normalised ratio.

Results

During a mean follow-up period of 37 months (6-76) there were 170 deaths among 1700 anticoagulant-treated patients and 189 among 1704 placebo-treated patients (hazard ratio 0.90; 95 CI 0.73-1.11). Recurrent myocardial infarction was observed in 114 and 242 patients, respectively (RR: 0.47; 0.38-0.59), cerebrovascular events in 37 and 62 patients, respectively (RR: 0.60; 0.40-0.90). Major bleeding complications were seen in 73 and 19 patients, respectively.

Conclusions

Long-term anticoagulant treatment with oral anticoagulants after myocardial infarction in low-risk patients has a limited effect on mortality but markedly reduces the risk of a cerebrovascular event or recurrent myocardial infarction.