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Thrombotic Complications of Antithrombotic Therapy: A Paradox with Implications for Clinical Practice

Gary E. Raskob, MSc; and James N. George, MD
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University of Oklahoma Health Sciences Center Oklahoma City, OK 73190 Requests for Reprints: Gary E. Raskob, MSc, Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190. Current Author Addresses: Mr. Raskob: Departments of Biostatistics and Epidemiology and Medicine, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190. Dr. George: Hematology-Oncology Section, University of Oklahoma Health Sciences Center, Box 26901, Oklahoma City, OK 73190.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1997;127(9):839-841. doi:10.7326/0003-4819-127-9-199711010-00012
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Heparin and warfarin have been the standard therapy for thromboembolic disease for more than 50 years. During this time, the clinical indications for their use have expanded. Heparin is the standard initial therapy for acute venous thrombosis or pulmonary embolism; it is also widely used to treat acute coronary syndromes and prevent thrombosis during vascular surgery or angioplasty, ex vivo thrombi during cardiopulmonary bypass surgery and hemodialysis, and postoperative venous thromboembolism in high-risk patients. The use of warfarin has also expanded in recent years to include prevention of thromboembolic stroke in patients with atrial fibrillation, a condition that affects many thousands of elderly patients each year in the United States. The wider use of warfarin has been facilitated by the finding that the risk for bleeding is reduced (without loss of antithrombotic efficacy) when the warfarin dose is adjusted to achieve a less intense anticoagulant effect than had been used in North America in previous years [1].

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