Royston, G. R.
March 1967
Angiology;Mar1967, Vol. 18 Issue 3, p133
Academic Journal
Patients with coronary disease (461 cases) have been treated with anticoagulants for from 6 months to over 8 years, a total of more than 1150 treatment years. The method of control of the ACT is described and the degrees of control assessed. It is emphasized that a case should be adequately anticoagulated at least 85 per cent of the time in order to render treatment effective. It is stressed that descriptions of ACT must include data of the degree of control in order that the prescribed therapy can be shown to have been carried out. The survival rate after myocardial infarction with or without previous infarction and with or without angina at 3 years and 5 years for the combined sexes was 91 per cent and 83 per cent respectively. The corresponding figures for males only are 92 per cent and 84 per cent. In terms of man-months, the male mortality was 0.33 per 100 man-months. The survival rate in angina alone was 93 per cent and 86 per cent at 3 years and 5 years, or a mortality rate of 0.26 per 100 man-months for males alone. Total male relapses, including fatal ones, were 0.42 per 100 man-months for myocardial infarction and 0.16 for angina only cases. Comparison with previously described series treated without anticoagulants shows diminished recurrence rate and decreased mortality in the treated series both for the angina only group and the myocardial infarction with or without angina group. The improved prognosis in males on ACT relates to both the under and over age 55 groups, particularly the former, and extends for at least 5 years. The numbers were insufficient for analysis of the females separately. Long-term anticoagulant therapy is indicated in males with angina or following infarction irrespective of age provided they are otherwise fit to lead a normal life for their age. The limit to the duration of effective long-term ACT is not yet apparent. Further studies on ACT in coronary disease should concentrate on the degree of control therapy achieved.


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