Wessler S
Cardiovasc Clin. 1977;8(1):131-8.
Although there is no statistical proof of the efficacy of coumarin drugs in the therapy of acute myocardial infarction, the numbers of patients at risk from thromboembolism are sufficiently great and the favorable clinical and pathologic impressions are sufficiently strong that, conversely, the possibility of benefit cannot be excluded. This delicate balance is indeed a Hobson's Choice. In this therapeutic dilemma, we would interpret one acceptable course in regard to the use of anticoagulants among patients with acute myocardial infarction as follows: all patients with proved acute myocardial infarction should be treated with anticoagulants while hospitalized unless there are relative or absolute contraindications to the therapy or deficiencies in laboratory facilities. Patients with questionable infarcts should be treated with anticoagulants only until the diagnosis is established or rejected. If the latter occurs, the administration of the drug should be discontinued. When, in a patient suspected of having an acute myocardial infarction, there is reason to believe that the pain may be due to pericarditis, dissecting aneurysm, or gastrointestinal abnormalities, anticoagulant therapy should be withheld until this is resolved.
尽管没有统计学证据证明香豆素类药物在急性心肌梗死治疗中的疗效，但面临血栓栓塞风险的患者数量足够多，且临床和病理方面的良好印象足够强烈，反之，获益的可能性也不能排除。这种微妙的平衡确实是一种别无选择的选择。在这种治疗困境中，我们对急性心肌梗死患者使用抗凝剂的一种可接受方案的解释如下：所有已证实为急性心肌梗死的患者在住院期间都应接受抗凝治疗，除非存在该治疗的相对或绝对禁忌症或实验室设施不足。梗死情况存疑的患者仅应在诊断确定或排除之前接受抗凝治疗。如果排除了梗死，则应停止用药。当怀疑患有急性心肌梗死的患者有理由认为疼痛可能是由心包炎、夹层动脉瘤或胃肠道异常引起时，应暂停抗凝治疗，直至问题解决。
