Problems associated with long-term anticoagulant therapy. Observations in 139 cases.

LONG-TERM anticoagulant therapy is being used frequently in the management of certain vascular and thromboembolic diseases. Results predominantly favorable in respect to prolonged survival and decreased morbidity have been reported from use of coumarin anticoagulants in these diseases.1-4 However, there has not been adequate evaluation of the ease or difficulty with which a satisfactory and practical program of prolonged anticoagulant therapy can be carried out. The purpose of this paper is to evaluate this aspect of anticoagulant therapy in ambulatory patients with vascular and thromboembolic diseases who have been observed during the past 1011⁄22 years. The following specific problems were considered: (1) the adequacy of control of prothrombin activity, (2) the hemorrhagic complicatious occurring during treatment, (3) the vascular and thromboembolic complications occurring during treatment, (4) the reasons for discontinuing treatment, (5) the vascular and thromboembolic complications that occurred immediately following cessation of treatment, and (6) the problems occasioned by surgery in patients on treatment.