The effect of warfarin on mortality and reinfarction after myocardial infarction

Article Abstract:

If a blood clot (thrombus) forms in one of the coronary arteries, which bring blood to the heart muscle, this may block the artery and cause a myocardial infarction (MI, heart attack). Patients who survive the acute phase of an MI are at risk for another heart attack. It has been suggested that oral anticoagulants, drugs that decrease the tendency of the blood to clot, may reduce the risk of another heart attack. This possibility has been studied extensively, but it is still not clear whether anticoagulants are beneficial to patients after an MI. This study, conducted in Norway, assessed the effects of long-term treatment with the oral anticoagulant warfarin. The subjects were men and women, aged 75 or younger, who had an MI an average of four weeks before entering the study; 607 subjects took warfarin and 607 took an inert placebo. The treatment lasted for an average of 37 months (the range was 24 to 63 months). After the study ended, it was determined that the risk of death was significantly reduced, by 24 percent, in the warfarin group as compared with the control group; there were 123 deaths in the control group and 94 in the warfarin group. The risk of having another MI was very significantly reduced (by 34 percent) in the warfarin group; the number of repeat MIs was 124 in the control group and 82 in the warfarin group. There has been some concern about the risk of cerebrovascular accidents (strokes) in patients taking anticoagulants, but it was found that the number of strokes was 55 percent lower among warfarin than control patients. It was concluded that long-term warfarin therapy has important positive effects in patients who survive an MI, and that its safety is acceptable. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Prevention, Heart attack, Anticoagulants (Medicine), Anticoagulants, Thrombosis

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Brief report: fatal hemorrhage in a patient with an acquired inhibitor of human thrombin

Article Abstract:

A 72-year-old woman suffered a fatal hemorrhage caused by the inhibition of the clotting factor thrombin. Her symptoms included rectal bleeding, bruises and a hematoma on her arm. Her clotting tests were abnormal. Despite blood transfusions and prednisone therapy the patient continued to hemorrhage internally and died. Tests of antibodies in the blood demonstrated the presence of an immunoglobulin G (IgG) antibody against thrombin. Most patients with IgG antibodies to thrombin have an underlying autoimmune disease or have been exposed to bovine thrombin during surgery. However, an extensive investigation and autopsy revealed no underlying disease and the patient had not been exposed to bovine thrombin. Patients with clotting disorders but normal platelet and fibrinogen levels should be tested for thrombin inhibitors and treated immediately.

Physiological aspects, Hemorrhage, Thrombin, Enzyme inhibitors

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High time for action

Article Abstract:

A case is described of a 58-year-old man who was hospitalized twice for a blood clotting disorder until doctors discovered that he had been taking warfarin that had been mistakenly prescribed instead of prednisone. The error occurred at the pharmacy where his prescription was filled.

Medication errors

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