COAGULATION TIME IN THE SELECTION OF CASES FOR ANTICOAGUJLANT TREATMENT BY

Anticoagulant therapy in cardiac infarction has raised several new problems. Its efficacy in reducing both mortality and complications appears to be beyond doubt. Tulloch and Gilchrist (1950) summarized the results in eleven earlier series and added their own figures: anticoagulants reduced the mortality from 29 to 15 per cent. The incidence of thrombo-embolic complications rose from 11 per cent before 1940 to 28 per cent between 1945 and 1948; these occurred in 28 per cent of Tulloch and Gilchrist's control cases but in only 13 per cent of their treated group. On the other hand anticoagulant therapy has disadvantages. Tromexan and dicoumerol necessitate frequent laboratory tests and few patients can be treated at home, thereby increasing the demands on hospital accommodation. Heparin is expensive and requires frequent intravenous injections the efficacy of intramuscular injections has yet to be proved. The mortality figures show that 15 per cent of patients with cardiac infarction will die and 71 per cent will recover whether anticoagulants are given or not; in 14 per cent anticoagulants may save life. Similarly they prevent complications in 15 per cent of cases. A maximum figure of 29 per cent includes all these for whom anticoagulants are essential; for the rest they are immaterial. The first problem is to differentiate those who require anticoagulants from those who do not