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April 25, 1980

Anticoagulant Therapy and Myocardial Infarction

Author Affiliations

Presbyterian Hospital of Pacific Medical Center San Francisco

JAMA. 1980;243(16):1629. doi:10.1001/jama.1980.03300420013007

To the Editor.—  The article by Szklo and associates (242:1261, 1979) and the accompanying editorial by Richard J. Jones, MD (242:1291, 1979), enter the controversial field of anticoagulant therapy in acute myocardial infarction and come strongly in favor of this therapy. Many followers of the 30-year-old controversy conclude that no valid study showing a favorable risk-benefit ratio of anticoagulant therapy has yet been designed. Presentation of a difference in mortality between treated and untreated patients is irrelevant to the subject, unless anticoagulant therapy or its lack is the only variable. The extremely broad range of clinical manifestations, complications, and risks of myocardial infarction makes it impossible to come up with well-matched groups without going into thousands of cases and preferably dealing with a prospective study.Many years ago McMichael,1 commenting on the early studies dealing with anticoagulant therapy of myocardial infarction, came up with a curious observation: In all