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March 31, 1956


JAMA. 1956;160(13):1101-1105. doi:10.1001/jama.1956.02960480001001

• The treatment of thromboembolism has been changed by the development of antibiotics and anticoagulants. The rationale of phlebotomy to remove thrombi and of ligation of large veins to prevent embolism is now questioned, since further surgery increases the circulatory difficulties and dangers. Ligation for thromboembolism is indicated only when anticoagulants are contraindicated or when embolism recurs in spite of them.

Unchanged, however, are certain other principles of treatment. If the healing processes cannot be aided, they must at least not be hindered. Warmth is valuable, but overheating must be avoided. It is particularly important to make sure that the arterial supply to the part is adequate, for the increased metabolic demands of warmed extremities will cause serious damage to tissues with inadequate blood supply.

These principles apply generally to superficial and deep thrombophlebitis, to acute subclavian thrombosis, migratory thrombophlebitis, subacute and chronic thrombophlebitis, peripheral embolism, and the postphlebitic syndrome. Anticoagulants have reduced the danger of pulmonary embolism and have improved the prospects of the patient with thrombosis of the central retinal artery. In mesenteric thrombosis, heparin is given as soon as the diagnosis is made, for the anticoagulant does not cause unusual bleeding during the necessary resection of the affected intestinal segment.