Key result
The one-stage prothrombin time was historically essential for the safe introduction and monitoring of oral anticoagulant therapy with bishydroxycoumarin, despite not measuring prothrombin specifically.
Provides a historical overview of the one-stage prothrombin time test and its role in the development of oral anticoagulant therapy.
Historical PT reliance for anticoagulation safety highlights assay limitations; leaves open need for prothrombin-specific monitoring today.
The one-stage prothrombin time was intimately associated with the development of oral anticoagulant therapy. As Link has stated: "Through it the hemorrhagic agent of spoiled sweet clover hay was laid out on the table in pure crystalline form." Furthermore, without this simple test, the introduction of bishydroxycoumarin (Dicumarol) into therapy would have been exceedingly hazardous. In the early studies,1the increased prothrombin time was regarded as a depression solely of prothrombin, and this assumption was supported by the finding that the 2-stage method of Warner, Brinkhous, and Smith2likewise showed a marked decrease of prothrombin when bishydroxycoumarin was given. The discoveries of Factor V (labile factor) in 1943,3and of a serum agent (Factor VII) a few years later,4,5made it evident that neither method measured prothrombin specifically. It was the one-stage test, however, which has received most of the criticism and been subjected to numerous
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Armand J. Quick (1963) conducted a review in Oral anticoagulant therapy. One-stage prothrombin time and bishydroxycoumarin (Dicumarol) was evaluated. The one-stage prothrombin time was historically essential for the safe introduction and monitoring of oral anticoagulant therapy with bishydroxycoumarin, despite not measuring prothrombin specifically.
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