Provides a comprehensive overview of anticoagulant therapy, emphasizing individualized treatment and careful clinical and laboratory monitoring.
The physician who undertakes anticoagulant therapy tampers with one of the most important homeostatic functions of the body. In so doing, he subjects the patient to the calculated hazard of possible hemorrhage balanced against the risks of the thrombosis or embolism that he seeks to prevent or treat. Agents currently employed are heparin and coumarin-type compounds. These two categories of anticoagulants act at different sites of the coagulation mechanism, are administered differently, are metabolized differently, are reversed by different antidotes, and their effects are measured by different tests. Certain facts about which the physician should be adequately informed have been presented regarding the hemostatic mechanism; the physiology and pharmacology of the anticoagulants, especially as they may explain the wide variation in individual response; certain aspects of methodology; and the various practical problems involved in therapeutic management. Emphasis has been placed on the importance of individualization of treatment, careful clinical observation, and frequent reliable laboratory tests as guides to proper therapy.
Alexander et al. (Sat,) studied this question.