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European Heart Journal Advance Access published online on January 9, 2006
European Heart Journal, doi:10.1093/eurheartj/ehi714
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received January 7, 2005
Revised December 12, 2005
Accepted December 15, 2005

Review

Long-term anticoagulant therapy in patients with coronary artery disease

S. E. Husted 1 *, B. K. Ziegler 2, and A. Kher 3

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

* To whom correspondence should be addressed.
S. E. Husted, E-mail: steen.husted{at}as.aaa.dk


  Abstract

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.

Keywords: Anticoagulation; Warfarin; Coronary artery disease; Prophylaxis; AMI.
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