Clinical effects of anticoagulant therapy in suspected acute myocardial infarction: systematic overview of randomised trials.

摘要: Abstract Objectives: Most randomised trials of anticoagulant therapy for suspected acute myocardial infarction have been small and, in some, aspirin and fibrinolytic were not used routinely. A systematic overview (meta-analysis) their results is needed, particular to assess the clinical effects adding heparin aspirin. Design: Computer aided searches, scrutiny reference lists, inquiry investigators companies identify potentially eligible studies. On central review, 26 studies found involve unconfounded comparisons versus control infarction. Additional information on study design outcome was sought by correspondence with investigators. Subjects: Patients Interventions: No routine among about 5000 patients 21 (including half one trial) that assessed alone or plus oral anticoagulants, routinely 68 000 six other addition intravenous high dose subcutaneous heparin. Main measurements: Death, reinfarction, stroke, pulmonary embolism, major bleeds (average follow up 10 days). Results: In absence aspirin, reduced mortality 25% (SD 8%; 95% confidence interval 10% 38%; 2P = 0.002), representing 35 (11) fewer deaths per 1000. There also (4) strokes 1000 (2P 0.01), 19 (5) emboli Conclusions: The evidence from does justify either treatment (irrespective whether any type used). Key messages Heparin seemed be useful who, past, had received neither nor available myo- cardial (whether used)