Anti-Coagulation therapy and its effect on myocardial infarction and angina

Mohammad Shamim

Introduction
Cardiovascular disease, especially coronary heart disease, contributes to substantial morbidity
and mortality in the United States and raises healthcare costs (Talbert R. 2008). An estimated 1.2
million persons in the United States will have a myocardial infarction by 2007 and increasing
(Shaw F. 2007). Myocardial infarction (MI) is one of the many cases of cardiovascular disease.
Angina is another case of cardiovascular disease. MI is heart attack, a heart attack occurs when
low blood flow causes the heart to starve for oxygen. Heart muscle dies or becomes permanently
damaged. Angina is chest pain or discomfort that occurs when an area of the heart muscle
doesn’t get enough oxygen-rich blood. To prevent MI we are testing patients to see if Warfarin
therapy will help reduce’ the risk of a heart attack, the occurrence of angina and the mortality
rate. Warfarin is an anticoagulant that reduces the clotting of the blood in blood vessels. Before
the use of warfarin on humans, it was used for rodenticide (Holbrook A. 2007). When a rodent
ingested the warfarin, the rodent started to have internal bleeding. After thorough testing of
warfarin it has been useful in reducing many cardiovascular conditions in human. Warfarin
therapy is strongly recommended for the prevention of stroke in moderate and high risk patients
with MI (Holbrook A. 2007). Studies in clinical settings have shown that warfarin’s effectiveness
is similar to that measured in randomized trials, but its utilization in clinical practice is lower
than expected (Holbrook A. 2007). Wafarin also has a cautious side effect that it requires
observation, is that if too much is administered it can cause a rupture of a blood vessel and cause
internal bleeding (Califf R. 2006). Warfarin can not only help one reduce MI and angina but also
can give improved survival rate of patients (Stenestrand U. 2006). Studies have shown that
anticoagulation such warfarin is more effective long term after MI and angina (Smith P.
1999)When we are testing patients we check to see the pro-thrombin time. Pro-thrombin time is
the time it takes for blood to coagulate. We hypothesize that warfarin will reduce MI, angina, and
the mortality rate of patients. The purpose of the study is to see if warfarin actually reduces MI,
angina and the mortality rate.
Methods

Results

Discussion
Patients in the study were divided into four groups, the first group is angina untreated. The total
number of patients in the group is 16. The average age is 65.4 years; average period of
observation in months is 20.4, the number of patients within the group living and well is 2, had
infarct without mortality is 8, had infarct but with mortality is 3, and unknown mortality is 3. The
second group is the angina treated group. The total number patients in the group are 15. The
average age is 57.2 years; average period of observation in months is 34.8, the number of
patients within the group living and well is 15, infarct without mortality is zero, infarct with
mortality is zero, and other mortality is zero. The third group is post-infarct untreated group. The
total number of patients in the group is 10. The average age is 62.1 years; average period of
observation in months is 35.3, the number of patients within the group living and well is 7,
infarct without mortality is 1, infarct with mortality is 2, and other mortality is zero. The last
group is the post-infarct treated group. The total number of patients in the group is 24. The
average age is 24; average period of observation in months is 30.5, the number of patients within
the group living and well is 23, infarct without mortality is zero, infarct with mortality is zero,
and unknown mortality is one. Due to the results being adequate we can conclude that the results
do support the hypothesis in that warfarin does reduce MI, angina and the mortality number in
patients.
The test was administrated on sixty patients and was separated into four groups. The number of
months the study lasted with patient participation was 20.4 to 35.3 months. The average age of
the patient in this study is 62.4 years. The patients were told to control their diet to help with the
study be more efficient. This study was biased towards male then to being equal, the study
contained fifty-three male and seven are female. Warfarin was given to patients either in office or
in a clinic, patients who received warfarin in the clinic, 50 to 75 mg. was given and followed
closely with pro-thrombin time determinations daily or every other day, until a successful
maintenance level was reached. Patients who received warfarin in the office, were scheduled to
25 mg. of warfarin sodium per day, and was maintained every day or every other day until a
therapeutic level was achieved. This study did not give enough information to the background of
the patients, environmental condition that they live in, if they have diet issues and history of
other health conditions. This study did not specify that the patient was aware of what the
medication that they are receiving is dangerous and if the medication is in a pre-trial era or not
(Holbrook A. 2007). This study cannot relate to the entire population, due to low population of
patient participation used.
Discussion Addendum
Throughout the years the treatments for cardiovascular disease have changed. Comparing to
1970’s to now we have newer technologies, medication, and many different therapies. Oral
anticoagulation is a new study where instead of injecting one of syringe the patients take a set
amount of pills (Smith P. 1999). Another form of cardio problem is Heart rate (HR) which has
been shown to be an independent predictor of all-cause and cardiac mortality, both in healthy
individuals and in patients with suspected or established coronary heart disease and its direct
association with coronary events has been documented (Dilaveris P. 2006). Due to the HR
spiking above normal and below normal, the pacemaker was established. The pacemaker
monitors the heart and activates when the heart skips a heart beat by providing a little bit of
electric shock (Dilaveris P. 2006). Another treatment and therapy for cardiovascular disease is
aspirin. Among patients with coronary artery disease (CAD), high-intensity and moderate-
intensity oral anticoagulants (OA) are effective in reducing MI and stroke but increase the risk of
bleeding. In the presence of aspirin, low-intensity OA does not appear to be superior to aspirin
alone, while moderate to high-intensity OA and aspirin vs. aspirin alone appears promising and
the bleeding risk is modest, but this requires confirmation from ongoing trials (Anand S. 1999).
While we proceed toward the future there will be more and more treatment, technologies, and
medications that will emerge to help reduce the cardiovascular disease throughout the world.
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