Considerable experience by many independent workers with the use of anticoagulants in the treatment of certain types of heart disease has shown that such therapy reduces significantly the incidence of thromboembolic complications and, largely through this effect, the morbidity and mortality rate from heart disease of these types. This is certainly established in acute coronary occlusion with myocardial infarction and in those instances of rheumatic heart disease with auricular fibrillation in which repeated embolic phenomena have occurred. The case for the administration of the anticoagulants in congestive heart failure is less secure, although there is no doubt that the number of thromboembolic complications is reduced by use of them. The administration of the anticoagulants requires considerably more exacting attention than does the administration of the majority of therapeutic agents in use commonly today. Hence, it is suggested that the use of anticoagulants in heart disease be restricted to those instances in which the indications are clear and facilities are compatible with the efficient and safe use of the drug, whether Dicumarol or heparin.

Anticoagulants↗

PubMed1950

The administration of anticoagulants.

Heparin is administered parenterally. Its therapeutic effect is measured by the clotting time of the whole blood, determined by the method of Lee and White. An excessive anticoagulant effect is controlled by the administration of specific antagonists, toluidine blue or protamine sulfate. Dicumarol* is admintered orally in amounts sufficient to reduce the prothrombin activity of the plasma to between 10 and 30 per cent of normal. The prothrombin time, which represents such a reduction in prothrombin activity, will vary according to the method by which the determination is performed, the thromboplastin used, and the technique followed. Excessive prolongation of the prothrombin time is antagonized by the administration of vitamin K in large doses. Long-term therapy with Dicumarol is sufficiently hazardous to require considerable experience on the part of the physician. Where an immediate anticoagulant effect is necessary, yet prolonged administration anticipated, combined therapy with both heparin and Dicumarol may be used until the prothrombin time is prolonged satisfactorily, whereupon heparin may be discontinued.

Anticoagulants↗

PubMed1949

The use of anticoagulants in the treatment of myocardial infarction.

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Anticoagulants↗