title: Use and effectiveness of intravenous heparin therapy for treatment of acute myocardial infarction in the elderly.
abstract: OBJECTIVE
  We sought to determine the use and association with 30-day mortality of intravenous heparin for the treatment of acute myocardial infarction in elderly patients not treated with a reperfusion strategy and without contraindications to anticoagulation.
  
  
  BACKGROUND
  The benefit of using full-dose intravenous heparin for the treatment of acute myocardial infarction in the elderly is not known.
  
  
  METHODS
  We conducted a retrospective cohort study using hospital medical records of all Medicare beneficiaries admitted to the hospital with an acute myocardial infarction in Alabama, Connecticut, Iowa and Wisconsin from June 1992 through February 1993.
  
  
  RESULTS
  Among the 6,935 patients > or = 65 years old who had no absolute chart-documented contraindications to heparin, 3,227 (47%) received early full-dose intravenous heparin therapy. After adjustment for baseline differences in demographic, clinical and treatment factors between patients with and without heparin, the use of heparin (odds ratio 1.02, 95% confidence interval 0.87 to 1.18) was not associated with a significantly better 30-day mortality rate.
  
  
  CONCLUSIONS
  Although intravenous heparin was commonly used for treatment of acute myocardial infarction in the elderly, it was not associated with an improved 30-day mortality rate. Although the findings of this observational study must be interpreted with care, they lead us to question whether the prevalent use of intravenous heparin has therapeutic effectiveness in this population.
authors.affiliation: Section of Cardiovascular Medicine, Yale School of Medicine, Yale University, Yale-New Haven Hospital Center for Outcomes Research and Evaluation, Connecticut 06520-8025, USA. harlan.krumholz@Yale.edu
authors.forename: H M
authors.initials: HM
authors.lastname: Krumholz
authors.forename: J
authors.initials: J
authors.lastname: Hennen
authors.forename: P M
authors.initials: PM
authors.lastname: Ridker
authors.forename: J E
authors.initials: JE
authors.lastname: Murillo
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.forename: V
authors.initials: V
authors.lastname: Vaccarino
authors.forename: E F
authors.initials: EF
authors.lastname: Ellerbeck
authors.forename: M J
authors.initials: MJ
authors.lastname: Radford
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D006278:Medicare; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
chemical_list: D000925:Anticoagulants; D006493:Heparin