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August 3, 1970

An Exercise in Futility

JAMA. 1970;213(5):862-863. doi:10.1001/jama.1970.03170310140050

Anticoagulants have been provoking controversy ever since their introduction into medical therapeutics 23 years ago. Their use in coronary heart disease has proved to be particularly controversial. At one extreme, enthusiastic supporters prescribe them for all phases of myocardial infarction, including premonitory phase, acute episode, and convalescence, as well as for continued use after the infarction for prevention of recurrence. At the opposite pole, opponents of anticoagulant therapy dispute its value at any stage of coronary heart disease. The silent majority of practitioners vacillate between these extremes in search of appropriate indications. Critically reviewing the evidence, Douglas1 concludes that anticoagulants are indicated in acute myocardial infarction for prevention of thromboembolic complications, and in the long-term for reducing the incidence of recurrent infarction.

While only a few would strongly dispute the first indication, many more would take issue with the second. Is long-term anticoagulant prophylaxis, in fact, effective? The enthusiasm,