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European Heart Journal Advance Access originally published online on January 9, 2006
European Heart Journal 2006 27(8):913-919; doi:10.1093/eurheartj/ehi714
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Long-term anticoagulant therapy in patients with coronary artery disease

S.E. Husted1,*, B.K. Ziegler2 and A. Kher3

1Department of Medicine and Cardiology, University Hospital of Aarhus, Tage Hansens Gade 2, DK-8000 Aarhus C, Denmark
2Department of Clinical Pharmacology, University Hospital of Aarhus, Bartholinbygningen University of Aarhus, DK-8000 Aarhus C, Denmark
3Euthémis, 5-7 Av. du Générale de Gaulle, F-94160 Saint-Mandé, France

Received 7 January 2005; revised 12 December 2005; accepted 15 December 2005; online publish-ahead-of-print 9 January 2006.

*Corresponding author. E-mail address: steen.husted{at}as.aaa.dk

Secondary prevention of coronary events in coronary artery disease (CAD) patients with aspirin is generally accepted because of ease of administration, predictable safety, and proven efficacy. The use of long-term anticoagulant therapy with heparins, vitamin-K antagonists (VKAs), or thrombin inhibitors is, however, more controversial. During the last 40 years, several trials have been conducted in order to evaluate the role of anticoagulant therapy in patients with CAD as a protection against subsequent death and thrombo-embolic complications. The conducted trials are heterogeneous in many ways, concerning comparative medications, patient populations, endpoints and follow-up, which makes a standardized recommendation on the basis of these studies difficult. This review is an overview of the largest and best studies on this topic and discusses the scientific background for a possible use of VKA or an alternative anticoagulant treatment in CAD patients, looking at both the beneficial effects and the risk of bleeding.

Key Words: Anticoagulation • Warfarin • Coronary artery disease • Prophylaxis • AMI


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