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To the Editor:—
In reply to Dr. H. B. Eisenstadt's comments, the following should be considered: Our patient had rather severe nausea and vomiting during the first 2 to 3 weeks following infarction and was unable to take bishydroxycoumarin (Dicumarol). Due to this situation heparin was the anticoagulant of choice. I don't believe a fixed recommended schedule of both heparin and bishydroxycoumarin given immediately can be carried out on all patients, as Dr. Eisenstadt suggests, to avoid a mishap. The usual loading dose of bishydroxycoumarin is 200-300 mg. on the initial day, followed by 200 mg. on the second day. Since the site of action of bishydroxycoumarin and heparin in the clotting mechanism is entirely different, there is no reason to reduce the usual loading dose of bishydroxycoumarin even though the patient had been on heparin for three weeks. It might be pointed out that our patient's prothrombin time 24
Morrison FC. Complication of Dicumarol Therapy-Reply. JAMA. 1961;176(3):243. doi:10.1001/jama.1961.03040160062018
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