[Anticoagulant or antiaggregant therapy in the secondary prevention of myocardial infarct?].
The recent publication of the results of two large trials of secondary prevention of myocardial infarction with oral anticoagulants is causing a revival of interest for oral anticoagulants in this clinical setting. On the basis of these data, oral anticoagulants should be considered not only an effective preventive strategy, but, probably, more effective than antiplatelet agents, currently the standard therapy in the prevention of thrombosis in acute myocardial infarction. There are advantages and disadvantages for both these treatments, and an adequate balancing of expected risks and benefits has to be performed in each single patient. The present review summarizes rationales and main clinical results in the prevention of reinfarction with antiplatelet agents and with oral anticoagulants, and analyzes the reasoning to prefer the formers or the latters in daily clinical practice of secondary prevention of coronary artery disease. Also, an analysis of the benefit/risk ratio of antiplatelet agents (aspirin) and oral anticoagulants in the Italian health system is synthetically presented. Such an analysis can be useful for the formulation of general guidelines and may suggest a modification of currently established and widely popular therapeutic habits in the management of coronary artery disease in Italy.
De Caterina
R
R
Istituto di Fisiologia Clinica, CNR e Scuola Superiore di Studi Universitari e di Perpezionamento S. Anna, Pisa.
Gianetti
J
J
Simonetti
I
I
Gensini
G
G
D000284:Administration, Oral; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D000925:Anticoagulants / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D001241:Aspirin / Q000008:administration & dosage / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D006801:Humans; D007558:Italy; D009203:Myocardial Infarction / Q000191:economics / Q000517:prevention & control*; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D014859:Warfarin / Q000008:administration & dosage / Q000627:therapeutic use
D000894:Anti-Inflammatory Agents, Non-Steroidal; D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors; D014859:Warfarin; D001241:Aspirin