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Luca Testa, William Van Gaal, Giuseppe Biondi-Zoccai, Antonio Abbate, Graziana Trotta, Pierfrancesco Agostoni, Early decrease in coagulation activity after myocardial infarction is associated with lower risk of new ischaemic events: observations from the ESTEEM trial, European Heart Journal, Volume 28, Issue 14, July 2007, Pages 1782–1783, https://doi.org/10.1093/eurheartj/ehm139
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We have carefully read the interesting article of Christersson et al.1 focusing on the pivotal issue of risk stratification and prognosis in patients recovering from an acute myocardial infarction (AMI). Analysing data from a cohort of patients enrolled in the ESTEEM trial, the authors aimed at evaluating whether markers for thrombin generation, fibrin turnover, and activated thromboplastin time (APTT) were related to clinical outcomes and whether change in the level of these markers could predict the risk of new ischaemic events or bleedings.2 The authors concluded that in patients with recent AMI a reduction of an initially elevated coagulation activity identifies those at a decreased risk of new ischaemic events, regardless of whether this reduction occurs spontaneously or is induced by pharmacological treatment. In addition, they purported that patients with higher initial coagulation activity may benefit the most from long-term treatment with ximelagatran. Some issues, in our opinion, deserve attention and need a deeper examination in order to avoid possibly misleading conclusions.