Comparison of high-dose with low-dose subcutaneous heparin to prevent left ventricular mural thrombosis in patients with acute transmural anterior myocardial infarction

Article Abstract:

Heart attack, or myocardial infarction, is caused by a cutoff of blood supply to the heart and results in damage to the heart muscle. Recent studies concerning the use of anticoagulant medications following myocardial infarction are controversial, despite indications that anticoagulant therapy may diminish the development of blood clots, thrombosis, in the wall of the left ventricle, the heart's main pumping chamber. The risk of left ventricular mural thrombosis is embolism, clotted material passing into the circulation and blocking an artery, which may lead to other complications such as stroke. A study was designed to test the dose-effect relationship of the anticoagulant heparin in preventing thrombosis. High doses (12,500 units every 12 hours) were compared with low doses (5,000 units every 12 hours) among 221 patients with acute myocardial infarction. Echocardiography, in which reflected sound is used to measure heart function, was able to detect left ventricular mural thrombosis in 11 percent of the patients in the high-dose group, and in 32 percent in the low-dose group, 10 days after their heart attacks. One stroke occurred in the high-dose group, and four occurred in the low-dose group. One patient in the low-dose group died of pulmonary embolism. A common complication of anticoagulant therapy, hemorrhaging, occurred with the same frequency in both groups. The authors conclude that the high dose of heparin is more effective than the low dose in preventing thrombosis of the left ventricle.

Analysis, Evaluation, Dosage and administration, Heart ventricle, Left, Left heart ventricle, Echocardiography, Heparin

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A comparison of aspirin with placebo in patients treated with warfarin after heart-valve replacement

Article Abstract:

The addition of aspirin to anticoagulant drug therapy after heart-valve replacement offers a significant reduction in the risk of death from vascular causes or systemic embolism. Patients who have a heart valve replaced usually must take drugs for the rest of their lives to prevent the development of blood clots. A study of 370 patients who had heart-valve replacement surgery randomly assigned them to one of two groups: 186 patients took 100 milligrams of aspirin per day and 184 received a placebo, or inert substance. The aspirin and the placebo were taken in addition to the commonly used anticoagulant warfarin. The patients' health status was followed for up to four years. Aspirin reduced the risk of death from embolism or vascular causes by 77%. A major systemic embolism or death from any cause occurred in 13 of the patients taking aspirin and in 33 of the patients taking the placebo. The risk of bleeding increased with the addition of aspirin and four patients in the aspirin group had five nonfatal intracranial hemorrhages. Three cases of fatal intracranial hemorrhage occurred in the study groups.

Health aspects, Innovations, Aspirin, Heart valve replacement

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Prognostic importance of myocardial ischemia detected by ambulatory monitoring early after acute myocardial infarction

Article Abstract:

Diagnosis of myocardial ischemia with an electrocardiograph (ECG) following a heart attack may be useful in predicting the risk of future heart problems. Myocardial ischemia is the shortage of blood supply to heart muscle. Researchers administered 24-hour, ambulatory ECG tests to 406 people, five to seven days following a heart attack. They also administered standard, less convenient prognostic tests: the exercise stress test and heart imaging tests. Ischemia was detected in 23% of the people. The death rate after one year was 12% among people with ischemia and 4% among those without ischemia. In comparison with the standard stress test, the ECG was better able to predict the risk of another heart attack or severe chest pain. However, none of the tests could predict the risk of death better than the standard symptomatic information.

Prognosis, Electrocardiograph, Electrocardiographs

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