The New Dimensions of Warfarin Prophylaxis pp 159-163 | Cite as
Two-Step Warfarin Therapy for the Prophylaxis of Venous Thrombosis After Elective Surgery
Abstract
A recurrent theme in the management of patients subjected to major surgical procedures has been the need for safe but effective anti-thrombotic treatment. This is an especially difficult dilemma for extensive bone or joint repair or replacement surgery, during which the prothrombotic tendencies would appear to require the use of more intensive anticoagulant therapy. Thus, Sevitt and Gallagher demonstrated a clearcut decrease in clinical deep vein thrombosis and pulmonary embolism and in autopsy-proven thrombotic disease with coumarin therapy before repair of hip fracture, but this was achieved at an increased risk of bleeding complication (Table 1).
Keywords
Deep Vein Thrombosis International Normalize Ratio Prothrombin Time Recurrent Deep Vein Thrombosis Prothrombin Time RatioPreview
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References
- 1.S. Sevitt and N.G. Gallagher, Prevention of venous thrombosis and pumonary embolism in injured patients. Lancet 2:981 (1959).PubMedCrossRefGoogle Scholar
- 2.J.B. Vanderveer, A.P. Parker, and F.R. Boyer, Emergency appendectomy in a patient receiving anticoagulants for myocardial infarction. JAMA 149:1307 (1952).CrossRefGoogle Scholar
- 3.S. Mullertz and O. Storm, Anticoagulant therapy with dicumarol maintained during major surgery. Circulation 10:213 (1954).PubMedCrossRefGoogle Scholar
- 4.J.K. Littman and H.R. Brodman, Surgery in the presence of the therapeutic effect of dicumarol. Surg Gyne Obstet 101:709 (1955).Google Scholar
- 5.H. Rustad and E. Myhre, Surgery during anticoagulant treatment. THe risk of increased bleeding in patients on oral anticoagulant treatment. Acta Med Scand 173:115 (1963).PubMedCrossRefGoogle Scholar
- 6.C.W. Francis, V.J. Marder, C. McCollister Evarts, and S. Yaukoolbodi, Two-step warfarin therapy. Prevention of postoperative venous thrombosis without excessive bleeding. JAMA 249:374 (1983).PubMedCrossRefGoogle Scholar
- 7.E.A. Loeliger, The optimal therapeutic range in oral anticoagulation. History and proposal. Thrombos Haemost 42:1141 (1979).Google Scholar
- 8.E.A. Loeliger, A.M.H.P. van den Besselaar, and S.M. Lewis, Reliability and clinical impact of the normalization of the prothrombin times in oral anticoagulant control. Thrombos Haemost 53:148 (1985).Google Scholar
- 9.S.N. Gitel and S. Wessler, Dose-dependent antithrombotic effect of warfarin in rabbits. Blood 61:435 (1983).PubMedGoogle Scholar
- 10.D.A. Taberner, L. Poller, R.W. Burslem, and J.B. Jones, Oral anticoagulants controlled by the British comChapautive thromboplastin versus low-dose heparin in prophylaxis of deep vein thrombosis. Br Med J 1:272 (1978).PubMedCrossRefGoogle Scholar
- 11.R. Hull, J. Hirsh, R. Jay, C. Carter, C. England, M. Gent, A.G.G. Turpie, D. McLoughlin, P. Dodd, M. Thomas, G. Raskob, and P. Ockelford, Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. New Engl J Med 307:1676 (1982).PubMedCrossRefGoogle Scholar