Long-term anticoagulant therapy in patients with coronary artery disease.
Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications. The conducted trials are heterogeneous in many ways, concerning comparative medications, patient populations, endpoints and follow-up, which makes a standardized recommendation on the basis of these studies difficult. This review is an overview of the largest and best studies on this topic and discusses the scientific background for a possible use of VKA or an alternative anticoagulant treatment in CAD patients, looking at both the beneficial effects and the risk of bleeding.
Husted
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Department of Medicine and Cardiology, University Hospital of Aarhus, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark. steen.husted@as.aaa.dk
Ziegler
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BK
Kher
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D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000517:prevention & control*; D004338:Drug Combinations; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D016032:Randomized Controlled Trials as Topic; D014812:Vitamin K / Q000037:antagonists & inhibitors
D000925:Anticoagulants; D004338:Drug Combinations; D005343:Fibrinolytic Agents; D006495:Heparin, Low-Molecular-Weight; D014812:Vitamin K; D001241:Aspirin