الفهرس 
Material and methodsOnly 14 pages are availabe for public view
 |  | from | 137 |  |  |
| | | from | 137 | | |
Abstract
102.
SUMMARY AND CONCLUSION
Myocardial infarction has become one of the most
important diseases in technically advanced countries.
Anticoagulants have been used for more than thirty-fou
years in the management of the acute phase of the dise se
but whether routine anticoagulation should be adopted r
not is still not settled. This is why we planned our tudy
in a trial to re-evaluate the possible benefits and ha ards
of such therapy.
Twenty patients admitted to Tanta Coronary Care ’nit,
suffering from acute myocardial infarction have been s udied.
Ten of them were on anticoagulation therapy and ten WE ’e
not, thus serving as controls.
The patients were studied as regards the relevant
risk and prognostic factors available in their files: ’ge
and sex, site and size of the infarct, presence or a bs e nce
of previous infarction, heart failure, hyperglycaemia,
hypercholesterolaemia, hypertension, arrhythmias and I lematocrit
valu~ systolic time Interval, The control and
anticoagulated groups were evaluated statistically anI they
proved to be comparable.
Both groups were studied to find statistically i any
correlation existed between any complications and the
individual risk and prognostic factors mentioned abov,
103.
In conclusion, by using anticoagulants in the mangement
of acute myocardial infarction, life long serious dis r bi Ld t y
may be decreased or abolished through a beneficial inf .uence
on the incidence of arterial thromboemboli. This is ~ :complished
without singificantly altering the mortality I s t e
in either direction.
In other words, by using anticoagulants, we are 1 eying
to’add ”Life to the years, if not years to the life oj our
patients”.
CONCLUSION:
1. Anticoagulation should be the therapy of choice or
acute myocardial infarchen. Preventing or imped ng
the progression of coronary thromboisis could p event
infarction or limit infarct size, and prevent re nfarction.
Furthermore, anticoagulation should reduc the
incidence of two major complications of myocardi I
infarction systemic embolism and pulmonary embol sm.
2. Mortality from myocardial infarction has markedl
diminished after the advent of the era of corona y care
uni t s,
3. The incidence of thromboembolism is diminshed by early
mobilization.
104.
4. The incidence of thromboembolism is higher in the ”high
risk” groups, in patients with diseased blood ves els,
and in those conifned to bed for long periods.
5. There is no definite proof that anticoagulant alt r
today the overall mortality or the extension of a
thrombus in the coronary tree, in the acute phase of
myocardial infarction.
6. Anticoagulants do decrease the rate of thromboemb lism
to a more significant level in the patients with
higher incidence of this complication.
7. The incidence of thromboembolism, especially arte ial,
is markedly diminished by anticoagulation. Becau e
of this fact, properly controlled anticoagulant terapy
is justified in the acute phase of myocardial inf rction
to avoid potentially serious disability that migh be
permanent.
Given our interpretation of the data available on the
efficacy of anticoagulation in acute myocardial infarc :ion
we have adopted the following recommendations in our
coronary care unit. On admission, low-dose heparin iE
begun if the suspect myocardial infarction is ruled Ot ”’
heparin is discontinued; if the diagnosis of definite
myocardial infarction is established, low-dose heparir is
105.
continued until the patient is ambulatory. We belivE that
low-dose heparin. given its low morbidity. is ap pro pri i t e
to further decrease the low incidence of pulmonary eml i lt am ,
We reserve the use of full-dose heparinization to tho, ~
patients at increased risk of plumonary embolism. We reserve
the use of ful-dose heparinization to those patients, t
increased risk of pulmonary embolism. Increased risk )f
symtemic embolism because of past history of systemic
embolism or the presence of atrial fibrillation.
------ ...._------------ -------- - --- ------- ---_.----