EDITORIALS Theory and Practice of Minidose Heparin in Surgical Patients

amounts that will not even budge the whole-blood clotting time, possibly provide effec-tive anticoagulant protection? " This is the most frequently asked and also the most intriguing question concerning prophylactic regimens employ-ing low doses of heparin in surgical patients. Such concerns are not new. Almost one quarter of a century ago DeTakats suggested that: "It takes much less heparin or Dicumarol to prevent clotting than to treat it." ' Bauer, in 1954,2 and Leggenhager, in 1957,3 recommended small doses of heparin after surgery to reduce the incidence of postoperative thrombosis. Subsequently, Sharnoff reported that patients receiving subcutaneous heparin prior, dur-ing, and subsequent to surgery had less pathologi-cally demonstrable thromboembolism at necropsy than those receiving the anticoagulant only subse-quent to surgery, and that the latter group did no better than untreated patients given no anticoagu-lant therapy in relation to their surgery.4 He believes that operative and postoperative thrombo-sis relates to the role of the pulmonary megakaryo-cytes in the development of "hypercoagulability."5 Sharnoff's prophylactic regimen consists of th