The Case for Anticoagulant Therapy

PERHAPS it is best to introduce this discussion with a few general statements to clarify the position which we have maintained throughout the past years. We have held that anticoagulant therapy for myocardial infarction does not constitute tlhe ultimate, the comprehensive, or even an entirely satisfactory form of therapy for this condition. If research directed at the prevention or reversal of atherosclerosis is crowned with success, the need for anticoagulant therapy will be decreased proportionately. Meanwhile, however, efforts to minimize the thrombotic tendency in the chambers and the progressively narrowing arteries of the heart and other organs, and also in the venous systems seems a logical and effective method of approach. Second, we have urged the pursuit of excellence. We do not consider that either inadequate or excessive use of these drugs is defensible, or that conclusions regarding their value can justifiably be drawn from such experiences. The disappointing and occasional tragic effects of their use have too often been an index of the percentage of time the patients have not been at optimal therapeutic levels as well as the lack of training or conscientiousness of the responsible clinician, laboratory technician, or the patient, rather than the drug itself. Untoward effects have frequently also been a result of unrecognized