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March 13, 1967

Heparin Treatment of Thromboembolic Disease

JAMA. 1967;199(11):862. doi:10.1001/jama.1967.03120110134037

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To the Editor:—  Dr. Gurewich and his associates can only be applauded for the emphasis on massive heparinization in acute thromboembolic disease (199:116, 1967). Intermittent intravenous administration of heparin in 100- to 150-mg doses, four to six times a day in the acute phase of thromboembolism, has been employed by us since 1941 (JAMA142:527, 1950, and the fact that the patient's response to heparin fluctuates from resistance to sensitivity was demonstrated in 1943 by a simple in vivo heparin tolerance test (Surg Gynec Obstet77:39, 1943).I would strongly differ, however, with their recommendation for the maintenance of two to three times normal control value for the continued treatment of thromboembolism. In my experience, the initial massive doses of 60,000 to 100.000 units a day lead often to clotting times well exceeding one hour without any evidence of bleeding. However, the dosage of heparin has to