Evidence favoring the use of anticoagulants in the hospital phase of acute myocardial infarction

N Engl J Med. 1977 Nov 17;297(20):1091-6. doi: 10.1056/NEJM197711172972004.


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.

Publication types

  • Clinical Trial
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Anticoagulants / adverse effects
  • Anticoagulants / therapeutic use*
  • Coumarins / therapeutic use
  • Drug Evaluation
  • Hemorrhage / chemically induced*
  • Heparin / therapeutic use
  • Hospitalization
  • Humans
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / mortality
  • Risk
  • Thromboembolism / prevention & control*


  • Anticoagulants
  • Coumarins
  • Heparin