Thromb Haemost 1985; 53(01): 137-140
DOI: 10.1055/s-0038-1661254
Original Article
Schattauer GmbH Stuttgart

Relationship Between Thromboembolic Complications and Intensity of Treatment During Long-Term Prophylaxis with Oral Anticoagulants Following DVT

Sam Schulman
The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
,
Dieter Lockner
The Thrombosis Unit, Department of Medicine, Huddinge University Hospital, Huddinge, Sweden
› Author Affiliations
Further Information

Publication History

Received 11 September 1984

Accepted 07 December 1984

Publication Date:
18 July 2018 (online)

Summary

The frequency of thromboembolic recurrencies during secondary prophylaxis after DVT was retrospectively studied and related to the intensity of the oral anticoagulation. All patients receiving oral anticoagulation after DVT at our hospital during April 1972 - May 1980 were studied. Treatment was given to 596 patients for 724 thrombotic events for a total of 4450 months. Thirty-six thromboembolic complications, all objectively verified, occurred. Patients with cancer had complications throughout the entire range of anticoagulation. Patients without neoplastic disease (15 events) never had complications below a prothrombin complex level of 27% as assessed with Simplastin A, corresponding to a BCT-ratio of 1.9. This study confirms, that the lower limit of the therapeutic range, determined by the risk of thromboembolic complications, should be set at a Simplastin A-level of approx. 25% corresponding to BCT 2.0.

 
  • References

  • 1 Allen EV, Barker NW, Waugh JM. A preparation from spoiled sweet clover. (3,3’-Methylene-Bis [4-Hydroxycoumarin].) Which prolongs coagulation and prothrombin time of the blood: a clinical study JAMA 1942; 120: 1009-1015
  • 2 Coon WW, Willis III PW, Symons MJ. Assessment of anticoagulant treatment of venous thromboembolism. Ann Surg 1969; 170: 559-568
  • 3 Lam-Po-Tang PR L C, Poller L. Oral anticoagulant therapy and its control: an international survey. Thrombos Diathes Haemorrh 1975; 34: 419-425
  • 4 Hull R, Hirsh J, Jay R, Carter C, England C, Gent M, Turpie AG G, McLoughlin D, Dodd P, Thomas M, Raskob G, Ockelford P. Different intensities of oral anticoagulant therapy in the treatment of proximal-vein thrombosis. N Engl J Med 1982; 307: 1676-1681
  • 5 Loeliger EA. The optimal therapeutic range in oral anticoagulation. History and proposal Thromb Haemostas 1979; 42: 1141-1152
  • 6 Loeliger EA, van den Besselaar AM H P, Broekmans AW. Intensity of oral anticoagulation in patients monitored with various thromboplastins. N Engl J Med 1983; 308: 1228-1229
  • 7 Korsan-Bengtsen K. Comparison between various methods used to control dicumarol therapy. Acta Med Scand 1970; 188: 327-335
  • 8 General Diagnostics. Simplastin A method description. 1983
  • 9 Sise HS, Lavelle SM, Adamis D, Becker R. Relation of hemorrhage and thrombosis to prothrombin during treatment with coumarin-type anticoagulants. N Engl J Med 1958; 259: 266-271
  • 10 Sevitt S, Innes D. Prothrombin-time and Thrombotest in injured patients on prophylactic anticoagulant therapy. Lancet 1964; 1: 124-129
  • 11 Pinto DJ. Controlled trial of an anticoagulant (warfarin sodium) in the prevention of venous thrombosis following hip surgery. Br J Surg 1970; 57: 349-352
  • 12 Bronge A, Dahlgren S, Lindquist B. Prophylaxis against thrombosis in femoral neck fractures - a comparison between dextran 70 and dicumarol. Acta Chir Scand 1971; 137: 29-35
  • 13 Bergqvist D, Dahlgren S. Leg vein thrombosis diagnosed by 125I- fibrinogen test in patients with fracture of the hip: a study of the effect of early prophylaxis with dicumarol or dextran 70. VASA 1973; 2: 121-126
  • 14 Taberner DA, Poller L, Burslem RW, Jones JB. Oral anticoagulants controlled by the British comparative thromboplastin versus low-dose heparin in prophylaxis of deep vein thrombosis. Br Med J 1978; 1: 272-274
  • 15 Hull R, Deimore T, Genton E, Hirsh J, Gent M, Sackett D, McLoughlin D, Armstrong P. Warfarin sodium versus low-dose heparin in the long-term treatment of venous thrombosis. N Engl J Med 1979; 301: 855-858
  • 16 Poller L. Oral anticoagulants reassessed. Br Med J 1982; 284: 1425-1426
  • 17 Stormorken H. Status i antikoagulasjonsbehandlingen. Tidsskr Nor Laegefor 1971; 12: 855-858
  • 18 Loeliger EA, Hensen A, Kroes F, van Dijk LM, Fekkes N, de Jonge H, Hemker HC. A double-blind trial of long-term anticoagulant treatment after myocardial infarction. Acta Med Scand 1967; 182: 549-566
  • 19 Sixty Plus Reinfarction Study Research Group. Risks of long-term oral anticoagulant therapy in elderly patients after myocardial infarction. Lancet 1982; 1: 64-68
  • 20 Mclnnes GT, Prentice AG. Documentation at an anticoagulant clinic. In: Begon FP. (Ed.) Proceedings of the 4th Annual WAMI Meeting.Politiers: Imp SIPAP 1981; pp 306-310