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Cooperative Study
August 17, 1964

Sodium Heparin vs Sodium Warfarin in Acute Myocardial InfarctionConclusions Based on Study of 798 Cases at 13 Hospitals

JAMA. 1964;189(7):555-562. doi:10.1001/jama.1964.03070070027007

SHOULD HEPARIN be viewed as the preferred anticoagulant in treatment of myocardial infarction? This question has received increasing attention since newer heparin preparations can be administered with more convenience and less expense than formerly. These practical considerations have enhanced the attractiveness of heparin as a "natural" anticoagulant which also possesses several other physiological properties—fast action, high margin of safety and low toxicity, and multiple effects on the clotting mechanism. Proponents of heparin are attracted also by potential benefits from antilipemic action and inhibition of platelet agglutination. Theoretically important, too, are the drug's actions in decreasing blood viscosity, inhibiting experimental pulmonary edema, and altering the partition of serum lipoproteins towards normal.1 This spectrum of activity, together with lessened need for careful laboratory control, would appear to offset the practical advantages of oral anticoagulants, ie, ease of administration and lower cost.

To evaluate the relative merits of heparin and warfarin in effecting

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