Long-term oral anticoagulant therapy for coronary artery disease

The findings of recent clinical trials have led to renewed interest in the role of oral anticoagulant therapy in patients with coronary artery disease. However, there are currently two major limitations to the routine use of oral anticoagulant therapy. The first is the need for laboratory monitoring and dose adjustment. This limitation may be overcome if fixed low doses of warfarin (e.g. 1 mg/day), which have antithrombotic effects, are shown by clinical trials to be effective and safe. A second limitation to oral anticoagulant therapy is uncertainty about its effectiveness and safety compared to aspirin, or in combination with aspirin. The current pathophysiologic knowledge and recent clinical trial data provide support for further clinical trials evaluating combined warfarin and aspirin treatment in the long-term care of patients with coronary artery disease, and in the primary prevention of myocardial infarction.