SERIAL PROTHROMBIN ESTIMATIONS IN CARDIAC PATIENTS: DIAGNOSTIC AND THERAPEUTIC IMPLICATIONS; USE OF DICUMAROL

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Abstract
No effect on the whole or diluted plasma prothrombin time was observed in a group of 18 cardiac patients who received digitalis for varying periods of time. Bed rest for periods of up to 7 wks. did not produce any change in prothrombin activity, except in a few cases in which a change was associated with the occurrence of thrombo-embolism. Ambulation did not effect prothrombin activity. The presence of congestive heart failure did not influence prothrombin activity, nor was any change observed following recovery from failure. In the cases of coronary occlusion, as well as those with repeated attacks of angina pectoris, there was no characteristic alteration in prothrombin activity. In 5 patients who had mural thrombosis of the cardiac chambers with embolism no specific change in prothrombin activity was noted. Eight cardiac patients developed thrombophlebitis or thrombo-embolism. In 4 of these there was no alteration in prothrombin time; in one case, there was an abnormal acceleration of the diluted plasma prothrombin time; and the remaining 4 showed a slight relative shortening of the diluted plasma prothrombin time when compared with the patient''s usual level, though the times remained within the normal range. Cardiac patients appear to be more sensitive to dicumarol than others. Cardiac patients with thrombo-embolism who were given an "avg." doze of 500 mg, of dicumarol over a period of 2 or more days developed excessive and dangerous elevations of the prothrombin time. The admn. of dicumarol to cardiac patients or any patients in a debilitated state must be done with caution.