Kaplan K
Arch Intern Med. 1986 Mar;146(3):593-7.
Although several large trials have failed to demonstrate unequivocally that anticoagulation decreases mortality following myocardial infarction (MI), anticoagulation has been advocated to prevent embolic cerebrovascular accidents (CVAs). Since CVAs occur during hospitalization in only 1.5% to 3% of MIs, it is not justifiable to anticoagulate all patients after MI because the risk of anticoagulation exceeds the potential benefit. However, a group of patients who are at high risk of developing left ventricular thrombi (LVT) and CVA following MI can be identified. Thirty percent to 40% of patients with transmural anterior MI develop LVT, and early anticoagulation with heparin sodium prevents LVT formation and CVAs in this group. A two-dimensional echocardiogram before hospital discharge allows the identification of patients at risk for later embolization and helps determine the need for anticoagulation with warfarin sodium following hospitalization.
尽管多项大型试验未能明确证明抗凝治疗可降低心肌梗死（MI）后的死亡率，但抗凝治疗仍被提倡用于预防栓塞性脑血管意外（CVA）。由于CVA仅在1.5%至3%的MI患者住院期间发生，对所有MI后患者进行抗凝治疗并不合理，因为抗凝治疗的风险超过了潜在益处。然而，可以识别出一组MI后发生左心室血栓（LVT）和CVA风险较高的患者。透壁性前壁MI患者中有30%至40%会发生LVT，早期使用肝素钠进行抗凝可预防该组患者LVT的形成和CVA。出院前进行二维超声心动图检查可识别有后期栓塞风险的患者，并有助于确定住院后使用华法林钠进行抗凝治疗的必要性。
