The Prothrombinopenic Effect of Massive Salicylate Therapy in Acute Rheumatic Fever

FOLLOWING the appearance of Coburn's report x advocating large doses of salicylates in rheumatic fever, interest in the problem of salicylate intoxica-tion has increased and warnings have been sounded regarding the dangers of salicylate therapy.2'8 Stress has been laid upon hemorrhage as one of the most striking of these complications, and case reports are cited of deaths from hemorrhage, but prothrombin levels were not determined in any of the fatal cases reported.4'5 Quick questioned the role of salicylate hypoprothrombinemia in the pro-duction of fatal hemorrhage, on the grounds that no evidence had been offered that prothrombin levels could be sufficiently reduced by salicylates to cause hemorrhage.6 Recently, Fashena and Walker7 reported prothrombin times of 60 to 90 seconds in six children treated with large doses of salicyl-ates, but made no mention of hemorrhage occurring in these patients. It is considered of interest, therefore, to report the following study, which was undertaken to determine the behavior of prothrombin in adults treated