Anticoagulants in treatment of patients with hip fracture

Publisher Website
Google Scholar
Abstract
Anticoagulant therapy is prophylactically effective against pulmonary emboli and can be employed with minimal risk of major hemorrhage. Pulmonary embolism in elderly immobilized patients is common, frustratingly difficult to diagnose, and surprisingly benign. It is occasionally and unexpectedly lethal. To recognize this fact statistically requires perhaps a series of 1,000 rather than 100 patients. The use of anticoagulant drugs to prevent pulmonary embolism requires overtreatment. It may be necessary to treat 100 patients who would have recovered spontaneously from pulmonary embolism to save 2 who would have succumbed. In such a therapeutic dilemma, the physician must be convinced that the risk of death from pulmonary embolism outweighs the risk from hemorrhage and sepsis. In anticoagulant therapy, one is invariably reminded of one''s failures but never of one''s successes. If one uses coumarin compounds and the patient bleeds, then it is the physician''s error. At the present state of knowledge, the burden of proof is on the physician who refuses to give anticoagulants to the elderly patient immobilized with a hip fracture in whom there is no contraindication to coumarin therapy.

This publication has 1 reference indexed in Scilit: