CHRONIC ANTICOAGULANT THERAPY IN RECURRENT EMBOLISM OF CARDIAC ORIGIN

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Abstract
In an attempt to prevent or to reduce the incidence of recurrent embolism, protracted anticoagulant therapy on an ambulatory basis has been carried out in 35 patient-courses among 28 patients who had already experienced one or more emboli of intracardiac origin. Although there are individuals in whom embolism continues to occur despite anticoagulant treatment, comparison of the clinical courses.prior to institution of therapy and during long-term anticoagulant therapy suggests a beneficial effect from the latter. One hundred-three emboli had occurred during 275 patient- months prior to such treatment; 13 emboli have occurred during 625 patient-months under therapy. There are certain individuals who seem to be considerably benefited. Furthermore, approx. 14 of the 17 patients in whom long-term use of the anticoagulant has been discontinued for 239 patient-months have suffered another embolism after cessation of Dicumarol treatment. It appears that once an individual has demonstrated a propensity to recurrent embolism for which prophylactic anticoagulant treatment has been administered, this therapy should be continued for an indefinite period. Since it has been shown that thrombi are restricted to the left auricular appendage alone in somewhat less than 50% of patients with mitral stenosis and left sided intracardiac mural thrombus, it appears that chronic anticoagulant treatment offers a sounder and more physiologic approach to the problem of recurrent embolism than do ligation and resection of the auricular appendage. Chronic ambulatory administration of anticoagulant is practical and safe provided there are careful professional supervision and reliable laboratory control. This group has received Dicumarol for a combined total of 625 patient -months, with only one instance of major hemorrhage.

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