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April 10, 1981

Prevention of Venous Thrombosis and Pulmonary Embolism

Author Affiliations

University of Connecticut Health Center School of Medicine Farmington Bradley Memorial Hospital Southington, Conn

JAMA. 1981;245(14):1477. doi:10.1001/jama.1981.03310390075037

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My initial impression in reviewing J. G. Sharnoff's Prevention of Venous Thrombosis and Pulmonary Embolism was that it was a somewhat evangelical attempt by the author to excite the heparin-thromboembolism establishment into a mystical realization that there is a difference between small-dose (his) and lowdose (theirs) heparin prophylaxis.

Then I spent a morning reviewing references (the monograph is well referenced) and my skepticism abated. The author, beginning in 1956, took a piece of pathological data (increased pulmonary megakaryocytes) and rudimentary laboratory data (increased platelets and decreased Lee-White clotting times in postoperative patients) and developed a theory (postoperative hypercoagulable state secondary to thrombocytosis related to stress of surgery and exacerbated by mobilization) that explained to him the high incidence of postoperative morbidity and mortality related to thromboembolic disease. His theory led him to the institution of a trial of prophylactic heparinization in which he strove to prevent hypercoagulable or hypocoagulable states