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Learning to live with the effects of a heart attack: long-term drug therapy: anticoagulant drugs

The medical layman must be made aware of the controversial medical opinions on anticoagulant drugs in long-term drug therapy for prevention of heart attacks and re-infarctions. We would like to emphasize this point because the patient will probably, be confronted with conflicting advice in the course of his treatment. The patient will then begin to worry and because of this controversy not a single question about medication is posed as frequently as those concerning anticoagulant medications.

Anticoagulant drugs impede the formation of blood clots, but do not thin the blood, as is sometimes incorrectly assumed.

Many factors are involved in the progression of coronary heart disease. Since the formation of blood clots is a significant factor in this progression, anticoagulant drugs play an important role.

Anticoagulant drugs per se cannot prevent a heart attack because the formation of blood clots is only one factor among many which causes heart attacks. The anticoagulant drugs can only lower the risk of suddenly blocking a coronary vessel with a blood clot.

Have medical studies shown that anticoagulant drugs are effective in the treatment of heart attack patients? Numerous studies have proven that patients treated correctly with anticoagulant drugs are less threatened by re-infarction than those who are not treated with these drugs. Additional studies have also demonstrated that the survival rate among patients treated with anticoagulant drugs is higher than among those not treated with them.

However, other studies have shown that anticoagulant drugs do not play a significant role in the long-term treatment to prevent re-infarction. Such conflicting conclusions may be due either to inaccurate control of the "Quick" prothrombin time levels or to the fact that the number of patients examined was too small to ensure unambiguous results.

There is also disagreement over how long anticoagulants may be taken. Although it has been generally agreed that anticoagulants are effective for 2 to 3 years after a heart attack, their continued effectiveness is disputed.

The following points of advice are important for anyone taking anticoagulants:

  1. Always carry your Quick levels (prothrombin time) with you. The desirable Quick's values lie between 10 and 25%, or about twice the control time.
  2. Have the Quick's test repeated as prescribed and keep a record of the values.
  3. Take your medication regularly in the prescribed dosage. Do not take additional medication for pain, rheumatism, or colds (particularly aspirin) without the permission of your physician, because even non-prescription drugs can have a harmful effect on the coagulation of blood.
  4. Inform every physician and dentist you visit that you are taking anticoagulants. You should not receive intramuscular injections.

Pay attention to any tendency toward bleeding and to the following warning signs: blue marks on your skin; bleeding of nose and gums; brownish discoloration or blood in the urine; and bright red blood in the bowel movement or tarry stools. In these instances stop taking the medication and contact your physician for instructions.

If you have a bleeding wound or injury press a sterile compress or clean towel on it until the bleeding stops or the doctor can be reached.

Patients who cannot be treated with anticoagulants for various reasons such as age or peptic ulcers, may be treated instead with certain other drugs which prevent the clumping of blood platelets. These drugs do not require constant laboratory monitoring as do anticoagulants.