This article discusses the rationale and historical evidence for using warfarin as secondary prophylaxis in patients with symptomatic venous thromboembolism.
There are two phases in the treatment of patients with symptomatic venous thromboembolism: initial treatment and secondary prophylaxis. Initial therapy usually consists of either subcutaneous low-molecular-weight heparin or intravenous unfractionated heparin, whereas oral vitamin K antagonists (such as warfarin) are generally prescribed for secondary prophylaxis.The evidence that an initial five-to-seven-day course of the direct-acting anticoagulant heparin is indeed warranted comes from two clinical trials. The first is the landmark 1960 study by Barritt and Jordan, who compared a combination of heparin and warfarin with no treatment in patients with symptomatic pulmonary embolism.1 The study was stopped prematurely after only . . .
Büller et al. (2003) studied this question.