Anticoagulant therapy

Abstract

Three phases of thromboembolic disease are recognized. In the first, acute phase, characterized by local symptoms and a general reaction of the body to a stressor stimulus, large doses of heparin are recommended. For the second phase, the body's own defense mechanism is beginning to work, and heparindosage has to be sharply cut or otherwise hemorrhage may occur. If properly treated, this phase then leads to a third phase of recovery in about two weeks. If not treated or insufficiently treated, a phase of delayed convalescence or "failed" convalescence appears, leading to chronic recurrent thromboembolic disease. If this is not arrested or if overwhelming thromboplastic substances are being continuously formed as occur in some cases of carcinomatosis, a terminal malignant phase supervenes which corresponds to a total exhaustion of the clotting mechanism. Heparin is still regarded as the best anticoagulant; its adequate use by surgeons should be studied as carefully as a technique of vena cava ligation or thrombectomy. © 1953.