The respective roles of thrombosis and spasm in the pathogenesis of coronary disease is a subject of current discussion. Critical study of trials of long-term secondary prevention of myocardial infarction carried out between 1967 and 1982 have failed to yield any definitive conclusion as to the value of oral anticoagulants, aspirin, sulfinpyrazone or dipyridamole. However oral anticoagulants should be prescribed in the long-term, in the absence of any contra-indication, in cases of myocardial infarction complicated by ventricular ectasia, arrhythmias or cardiac failure with cardiomegaly. The use of better methods in secondary prevention trials would be desirable. Primary prevention of myocardial infarction using drugs raises difficult problems, in particular economic.
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