Showing papers in "JAMA Internal Medicine in 1984"

The 1984 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure

Abstract: Since publication of the 1980 Report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure, 1 several events have occurred that affect successful management of hypertension: publication of major clinical trial results, introduction of new antihypertensive agents, evidence concerning effectiveness of nonpharmacologic treatment, and further analysis of the epidemiologic data-base relating BPs with the risk of premature morbidity and mortality. These events led the director of the National Heart, Lung, and Blood Institute (NHLBI), as chairman of the National High Blood Pressure Education Program Coordinating Committee, to establish a new Joint National Committee to revise earlier recommendations. This report includes recommendations on the following topics: (1) screening and referral procedures, (2) classification according to BPs, (3) use of nonpharmacologic therapies, (4) revised stepped-care approach, (5) management of mild hypertension, (6) patient-professional interaction, and (7) management of BP in special groups, including blacks, children, and pregnant

Subcutaneous and Mediastinal Emphysema: Pathophysiology, Diagnosis, and Management

Abstract: • Subcutaneous emphysema and pneumomediastinum occur frequently in critically ill patients in association with blunt or penetrating trauma, soft-tissue infections, or any condition that creates a gradient between intra-alveolar and perivascular interstitial pressures. A continuum of fascial planes connects cervical soft tissues with the mediastinum and retroperitoneum, permitting aberrant air arising in any one of these areas to spread elsewhere. Diagnosis is made in the appropriate clinical setting by careful physical examination and inspection of the chest roentgenogram. While the presence of air in subcutaneous or mediastinal tissue is not dangerous in itself, prompt recognition of the underlying cause is essential. Certain trauma-related causes may require surgical intervention, but the routine use of chest tubes, tracheostomy, or mediastinal drains is not recommended. ( Arch Intern Med 1984;144:1447-1453)

Quality of life and its predictors in patients with mild hypoxemia and chronic obstructive pulmonary disease

Abstract: • Measures of quality of life were obtained on 985 patients with mild hypoxemia and chronic obstructive pulmonary disease (COPD). A subsample of 100 patients were also given extensive neuropsychological and personality tests. Mildly hypoxemic COPD patients showed impairment in quality-of-life activities. They showed less impairment in physical function, compared with previous studies on COPD patients with hypoxemia, but about equal impairment in psychosocial function and dysphoric mood. Nonrelated health changes in life do not seem to account for these findings. Degree of self-reported tension-anxiety was the single greatest predictor of both physical and psychosocial measures of quality of life. Level of exercise completed, forced expiratory volume in 1 s, and neuropsychological status were significantly related to physical limitations, but not psychosocial functioning. The Pao2 was not significantly related to quality-of-life measures in this patient group. (Arch Intern Med1984;144:1613-1619)

Thromboembolism in Patients With the 'Lupus'-Type Circulating Anticoagulant

Abstract: • Thirty-five patients with the lupus anticoagulant (LA) were followed up between 1975 and 1982. The most prevalent clinical manifestation occurring in these patients was thrombosis. Nineteen patients (54.3%) had a single or recurrent thrombotic episode. Fifteen patients (42.8%) had venous thrombosis, and arterial thrombosis manifested by stroke or transient ischemic attacks occurred in six patients. Bleeding occurred in only five patients, four of whom had severe thrombocytopenia, while no excessive bleeding was noted during 18 operative procedures. Various therapeutic regimens, including corticosteriods, nonsteroidal anti-inflammatory drugs, cytotoxic or immunosuppressive agents, had no effect on the presence of the LA in these patients. Anticoagulants were successful in the treatment and prevention of thrombotic episodes. (Arch Intern Med1984;144:510-515)

Prevention of Acute Renal Failure in Traumatic Rhabdomyolysis

Abstract: • Following the collapse of a building, seven subjects (aged 18 to 41 years) were released from under the rubble within one to 28 hours. All seven suffered from extensive crush injuries with evidence of severe rhabdomyolysis and were treated by the induction of an alkaline solute diuresis immediately on their extrication from the debris. The leakage of muscle constituents was estimated by quantifying the net total body potassium losses, which averaged 395 mEq (SD, ±198) over the first 60 hours of therapy. In the past, injuries of similar severity have been associated with a high incidence of acute renal failure and a high mortality rate, yet none of our patients had azotemia or renal failure. We attribute this success to the unprecedented early institution of appropriate therapy. ( Arch Intern Med 1984;144:277-280)

Disorders of the Thymus: A Review

Abstract: The thymus remains one of the least understood organs in the body. It has gone from the villain to the hero. For many years, it was blamed for what is now recognized as the sudden infant death syndrome; now, its role of immunosurveillance is being recognized. In spite of the fact that there are only two predominant cell types within the thymus, there are nearly 15 histologically different neoplasms of the thymus. These, in turn, are associated with more than 20 parathymic syndromes that affect approximately 40% of patients with thymoma. The three most common of these syndromes associated with thymic disorders are myasthenia gravis (MG), pure red cell aplasia (PRCA), and hypogammaglobulinemia. Thymomas are found in 15% of patients with MG, 50% of those with PRCA, and 10% of those with adult-onset hypogammaglobulinemia. Of all thymomas, 35% are malignant, that is, invasive or metastatic.

A Double-blind Clinical Trial in Weight Control: Use of Fenfluramine and Phentermine Alone and in Combination

Abstract: • We performed a double-blind, controlled clinical trial comparing phentermine resin (30 mg in the morning), fenfluramine hydrochloride (20 mg three times a day), and a combination of phentermine resin (15 mg in the morning) and fenfluramine hydrochloride (30 mg before the evening meal), and placebo. We combined low doses of the two drugs to maintain efficacy while diminishing adverse effects. Eighty-one people with simple obesity (130% to 180% of ideal body weight) participated. Individualized diets were prescribed and discussed again during the 24-week study period. Weight loss in those receiving the combination (8.4±1.1 kg; mean±SEM) was significantly greater than in those receiving placebo (4.4±0.9 kg; Scheffe's test) and equivalent to that of those receiving fenfluramine (7.5±1.2 kg) or phentermine (10.0±1.2 kg) alone. Adverse effects were less frequent with the combination regimen than with other active treatments. Thirty-seven participants dropped out of the study, 18 for reasons related to drug treatment. Combining fenfluramine and phentermine capitalized on their pharmacodynamic differences, resulting in equivalent weight loss, fewer adverse effects, and better appetite control. ( Arch Intern Med 1984;144:1143-1148)

Sensitivity, Specificity, and Predictive Values of Closed Pleural Biopsy

Abstract: • To determine the clinical value of a nonspecific pleural biopsy specimen and fluid in malignant neoplasm and tuberculosis, we retrospectively reviewed records of all patients with pleural effusions undergoing the procedure at three community hospitals over six years. Two hundred eleven patients underwent biopsies. Adequate tissue was obtained in 207. The results were compared with the ultimate clinical and pathologic outcome by follow-up for 12 to 72 months. The initial procedure was diagnostic of malignant neoplasm in 54 patients and granulomatous disease in ten. A nonspecific or normal result was found in 143 (68%). Malignant neoplasms or tuberculosis was eventually established in 30 and excluded in 101 of the 143 patients. In 12 patients, no diagnosis was made. The procedure's sensitivities were 65% (malignant neoplasm) and 90% (tuberculosis). One false-positive result occurred in a patient with nontuberculous granulomatous pleuritis. The specificity and positive predictive value were 99% and 98%, respectively. The negative predictive value was 77%. Closed pleural biopsy with simultaneous fluid analysis is a valuable diagnostic procedure in community hospital patients, but a nonspecific result does not exclude malignant disease. (Arch Intern Med1984;144:325-328)

Predictors of clinical hypomagnesemia. Hypokalemia, hypophosphatemia, hyponatremia, and hypocalcemia.

Abstract: • Four studies were conducted, each determining the frequency of hypomagnesemia in patients already found to have one abnormal electrolyte determination. Hypomagnesemia occurred in 42% of patients with hypokalemia, 29% of patients with hypophosphatemia, 27% of patients with hyponatremia, and 22% of patients with hypocalcemia. These observations suggest that detection of either hypokalemia, hypophosphatemia, hyponatremia, or hypocalcemia, all of which are routinely available determinations, should alert the clinician to order serum magnesium determinations because of the frequent association of hypomagnesemia with these electrolyte perturbations. Optimally, levels of serum Mg should be determined on a routine basis because of the frequency of the occurrence of hypomagnesemia in hospitalized patients. (Arch Intern Med1984;144:1794-1796)

Heart Rate, Rate-Pressure Product, and Oxygen Uptake During Four Sexual Activities

Abstract: • Heart rate, rate-pressure product, and Vo 2 were measured in ten healthy men during four specified sexual activities: coitus with husband on top, coitus with wife on top, noncoital stimulation of husband by wife, and self-stimulation by husband. Foreplay generated slight, but statistically significant, increases above resting baseline in cardiac and metabolic variables. From stimulation through orgasm, average effort was modest for relatively short spans. Maximum exercise values occurred during the brief spans of orgasm, then returned quickly to near baseline levels. The two noncoital activities required lower expenditures than the two coital positions, with man-on-top coitus rating the highest. Large variations among subjects and among activities discourage use of a general equivalent activity for comparison, such as "two flights of stairs," to represent "sexual activity." ( Arch Intern Med 1984;144:1745-1748)

High-Dose Ketoconazole Therapy and Adrenal and Testicular Function in Humans

Abstract: • Ketoconazole, an oral antifungal, when given in conventional doses, transiently blocks testosterone synthesis and adrenal response to corticotropin. Higher therapeutic doses (ie, 800 to 1,200 mg/day), even once daily, caused more prolonged blockade. In some men, the serum testosterone concentrations were always subnormal. Bound and free testosterone values were equally diminished. Oligospermia and azospermia after prolonged therapy were noted. Impotence and decreased libido were found. Gynecomastia appeared more common than with lower doses. Depressed response to corticotropin was pronounced. Urine cortisol excretion was depressed. The blockade appeared related to the serum ketoconazole concentration. Instances of normal hormone levels or responsiveness were associated with low ketoconazole concentrations. The hormonal effects were generally unrelated to duration of therapy, although there may have been partial reversal with continued therapy. These effects appeared reversible with discontinuation of therapy. Patients receiving ketoconazole should be considered potentially unable to mount an adrenal stress response and may require testosterone supplementation. ( Arch Intern Med 1984;144:2150-2153)

Intravenous therapy team and peripheral venous catheter-associated complications. A prospective controlled study.

Abstract: • A prospective controlled trial was conducted on four similar inpatient medical wards to test the hypothesis that a trained Intravenous therapy (IVT) team would substantially reduce the incidence of peripheral intravenous (IV) catheter-related complications. We followed 863 IV catheters. The overall incidence of phlebitis in the ward staff—maintained IV catheters was 32% as compared with 15% for those maintained by the IVT team. The incidence of two more serious complications (cellulitis and suppurative phlebitis) was reduced tenfold from 2.1% to 0.2%. We conclude that an IVT team can substantially reduce the iatrogenic complications related to IV catheters. (Arch Intern Med1984;144:1191-1194)

Oral Manifestations of Chronic Graft-v-Host Disease

Abstract: • Sixty patients were studied 180 to 500 days after allogeneic marrow transplantation to determine if late oral abnormalities were associated with the presence of chronic graft-v-host disease (GVHD). Lip and intraoral mucosal surfaces were evaluated for color, keratinization, atrophy, and erythema. Subjective complaints of oral pain and xerostomia were also recorded. Abnormalities were scored on a scale of 0 to 3 and tested for association with GVHD by χ2test. Oral manifestations most strongly associated with chronic GVHD included atrophy and erythema or lichenoid lesions of the buccal and labial mucosa and oral pain. Oral manifestations resembled several naturally occurring autoimmune disorders. Recognition of these changes can aid in the clinical diagnosis and assessment of established chronic GVHD. (Arch Intern Med1984;144:1591-1595)

Complications associated with Staphylococcus aureus bacteremia.

Abstract: • Thirty-nine consecutive Staphylococcus aureus bacteremias were reviewed with particular attention to complications. Thirty-four (87%) of the bacteremias were nosocomial, with intravascular catheters (20 episodes) and dialysis-access sites (six episodes) the most common sources. Complications developed in 36% (14/39) of all bacteremias and in 30% (6/20) of those that were catheter-associated. Acute complications (shock, adult respiratory distress syndrome, disseminated intravascular coagulation) occurred in six patients and were fatal in four. In nine patients metastatic suppurative complications developed, six at sites of preexisting abnormalities. There were no episodes of endocarditis. Most patients received prolonged antibiotic therapy, and the majority of all suppurative complications required surgical intervention. Staphylococcus aureus bacteremia, even when not associated with endocarditis, is a cause of considerable morbidity and mortality in hospitalized patients. ( Arch Intern Med 1984;144:541-545)

Bacterial meningitis in the elderly.

Abstract: • To assess the implications of meningitis in a more mature population, we reviewed the records of patients with meningitis: 71 aged 50 years and older and 138 patients aged 15 to 49 years. Among the older population, 54 (76%) had bacterial, nine (13%) had granulomatous, and eight (11%) had aseptic meningitis. Among the cases of bacterial meningitis in the older age group, Streptococcus pneumoniae accounted for 24% (13/54) and enteric bacilli accounted for 17% (9/54). Serious complications occurred in 38 elderly patients (70%) with bacterial meningitis, and mortality occurred in 24 (44%). In the younger age group with bacterial meningitis, the complication rate and mortality were 41% (13/32) and 13% (4/32), respectively. Meningitis in the elderly is likely to be bacterial and to cause greater morbidity and mortality. ( Arch Intern Med 1984;144:1603-1607)

Criteria for weaning from prolonged mechanical ventilation.

Abstract: • We retrospectively studied 11 instances of patients requiring prolonged mechanical ventilation. Their spontaneous ventilatory measurements were not useful in judging their ability to wean, since these measurements did not change from the period of unsuccessful weaning to the period of progressive weaning from the ventilator. An adverse factor score and a ventilator score were created to evaluate underlying medical and respiratory problems related to ability to wean. Each score and the sum of the two scores separated patients between unsuccessful and successful weaning periods. We also found that the course and the duration of the entire weaning process could be predicted once progressive weaning had begun. We conclude that the adverse factor score and ventilator score correlate with the ability of patients receiving prolonged mechanical ventilation to wean. ( Arch Intern Med 1984;144:1012-1016)

Bacteremia in a Long-term Care Facility: Spectrum and Mortality

Abstract: • One hundred episodes of bacteremia were studied in a primarily geriatric population. Gram-positive bacteremia accounted for 24% of all bacteremia (50% mortality rate), while gram-negative bacteremia accounted for 67% of bacteremia (25% mortality); 9% of all bacteremias were polymicrobial in nature (67% mortality). Overall mortality was 35%. The urinary tract was the most frequently identified tissue source (56%) followed by skin and subcutaneous tissue (14%) and respiratory tract (10%).Escherichia coli, Proteusspecies, andKlebsiella enterobactergroup were the most common gram-negative organisms,Staphylococcus aureuswas the most common gram-positive organism and together they accounted for approximately 75% of all bacteremia. Fifty percent of deaths occurred within 24 hours of diagnosis of bacteremia, despite appropriate antibiotic therapy. This study may help to identify risk factors for bacteremia in elderly patients. (Arch Intern Med1984;144:1633-1635)

Wave Reflections and the Arterial Pulse

Abstract: • Studies of aortic dynamics have provided new information about the peripheral pulse. This brief review provides a summary of these findings and relates them to a number of clinical conditions. ( Arch Intern Med 1984;144:366-371)

Efficacy of Ipecac and Activated Charcoal/Cathartic Prevention of Salicylate Absorption in a Simulated Overdose

Abstract: • Twelve adult volunteers were given 24 81-mg aspirin tablets and were randomly assigned into the following treatment groups: (1) control aspirin, (2) 30 mL of ipecac repeated if vomiting not induced, (3) 60 g of activated charcoal per 15 g of magnesium sulfate (MgSO 4 ), and (4) ipecac repeated if needed, followed by activated charcoal/MgSO4 given 1½ hours after the last vomiting episode. All treatments began 60 minutes following aspirin ingestion. Urine was collected for 48 hours for percent total salicylate excretion. Mean SD recovery of salicylate from urine was as follows: aspirin, 96.3% ±7.5%; ipecac 70.3%±11.8%, activated charcoal/MgSO 4 , 56.4%±12%; and ipecac and activated charcoal/MgSO 4 , 72.4%± 14.1%. Ten subjects completed the study. In group 4, eight of ten subjects vomited the activated charcoal/MgSO 4 immediately, making statistical analysis impossible. Analysis revealed that activated charcoal/MgSO 4 significantly lowered the absorption of aspirin compared with the control and ipecac-treated groups. Furthermore, ipecac significantly lowered aspirin absorption compared with the control group. We conclude that activated charcoal/MgSO 4 used alone is superior to the other treatment modalities at inhibiting the absorption of multiple aspirin tablets. ( Arch Intern Med 1984;144:48-52)

How Good Is Communication Between Primary Care Physicians and Subspecialty Consultants

Abstract: • We prospectively studied the communication between 27 referring practitioners and their consultants for 464 consecutive patient referrals from a general internal medicine group practice at a university medical center. The rates of referral among practitioners varied from 0 to 28.1 per 100 patient visits. Though referring physicians provided patient background information in 98% of the cases, they made explicit the purpose of the referral in only 76% of the cases. They contacted consultants directly in only 9% of the cases. In return, consultants communicated their findings to referring practitioners in only 55% of the consultations. Referring physicians who personally contacted consultants or who supplied them with more clinical information were more likely to learn the results of the consultation. While communication between the referring physicians and consultants in this setting is limited, it may be improved if referring physicians supply more clinical information to consultants and contact them directly. ( Arch Intern Med 1984;144:1265-1268)

Transient Bacteremia and Endocarditis Prophylaxis

Abstract: Transient bacteremia is usually asymptomatic and thus of little clinical significance in most patients. Individuals with valvular heart disease are a notable exception, because circulating bacteria may lodge on damaged or prosthetic heart valves, resulting in bacterial endocarditis. Transient bacteremia can occur with many medical procedures, and the use of antibiotics to prevent endocarditis in the high-risk patient has become an accepted medical practice. This is based on the premise that microbial seeding of a damaged valve can be prevented by prior administration of antibiotics. 1-3 There is no direct evidence for the efficacy of this approach in man; therefore, recommendations must be based on studies using animal models. 1,4 The issue may never be completely resolved, because a controlled human study is not feasible. Based on a calculated risk of 0.2%, Durack 5 estimated that at least 6,000 patients who have valvular heart disease and are undergoing dental procedures

The Sexual History in General Medicine Practice

Abstract: Sexual problems have long been considered part of medical practice. Sigmund Freud's work, 1 in the early part of this century, set the course that led psychiatry, and then medicine and surgery, to become highly involved with problems of sexual functioning. Recent studies, 2,3 however, show that practitioners often neglect the sexual history. The sexual history should be considered part of the routine data base: (1) if the prevalence of sexual dysfunction is high, (2) if the sexual history itself is appreciated by patients and helpful to physicians, and (3) if the problems that are discovered are treatable. There is considerable information on the favorable outcome of therapy for psychologic and organic sexual problems. 4-8 Little is known, however, about the prevalence of sexual problems in the general medicine population or about the attitudes of physicians and patients concerning the sexual history. The findings of this study show that patients

Pulmonary dysfunction in 'freebase' cocaine users.

Abstract: Of 19 consecutive smokers of cocaine, "freebase" cocaine [ill]rs, admitted to a chemical dependence program, 12 (63%) respiratory symptoms and ten (58%) noted dyspnea. [ill]ormalities of carbon monoxide diffusing capacity were [ill] seen in ten of the subjects, although responses to steady[ill]te exercise testing were normal in subjects undergoing [ill]rcise. We believe that freebase cocaine use frequently [ill]duces pulmonary gas exchange abnormalities that appear [ill]r relatively brief periods of abuse. These abnormalities [ill]y persist after cessation of freebase cocaine use. A history [ill]his form of drug abuse should be sought when evaluating [ill]ents with appropriate symptoms or abnormalities of diffuscapacity. Arch intern Med1984;144:2195-2197)

Disseminated histoplasmosis in patients with the acquired immune deficiency syndrome.

Abstract: • The ongoing epidemic of acquired immune deficiency syndrome (AIDS) has affected homosexual men, intravenous (IV) drug abusers, Haitians, hemophiliacs, and others. Defects in cell-mediated immunity place these patients at risk for opportunistic infections. We recently saw three men from Alabama with disseminated infection due to Histoplasma capsulatum . Two of these men were homosexual and the other was an IV drug abuser. These three patients had evidence of depressed cellular immunity consistent with a diagnosis of AIDS. Infection caused by organisms indigenous to certain geographic areas of the United States may become more common in patients with AIDS as the epidemic continues. ( Arch Intern Med 1984;144:2178-2181)

Clinical and chemical assessment of thyroid function during therapy with amiodarone.

Abstract: • Clinical and chemical variables of thyroid function were studied in 26 patients with symptomatic ventricular tachyarrhythmias before and during long-term oral treatment with amiodarone. The mean (±SEM) pretreatment thyroxine (T 4 ) level in the 26 patients was 7.32±0.33 μg/dL, and increased notably to 10.15±0.47 μg/dL by 30 to 120 days after treatment. The free thyroxine index (FT 4 I) was also notably elevated. Clinical hyperthyroidism or goiter did not develop, but clinical hypothyroidism occurred in four patients during and in one patient after discontinuation of amiodarone treatment. Notable titers of antithyroid antibodies were found in the serum of two of the five and a family history of thyroid disease was present in three of the five hypothyroid patients. An elevation of both the T 4 level and the FT 4 I above the normal range is an expected finding in patients receiving amiodarone and does not by itself indicate hyperthyroidism. Patients with positive antithyroid antibodies or a family history of thyroid disease prior to treatment with amiodarone may be at an increased risk of hypothyroidism developing when treated with this drug. ( Arch Intern Med 1984;144:487-490)

Unusual manifestations of hypothyroidism.

Abstract: • Thyroid hormone exerts direct effects on essentially all of the organ systems of the body Hypothyroidism is a frequently diagnosed endocrine disorder that has characteristic clinical signs and symptoms In addition to these common manifestations, however, there are many additional manifestations of hypothyroidism that are less commonly acknowledged and Include involvement of the hematologic, muscular, cardiac, and rheumatologic systems It is important to recognize that these other organ systems may be involved and that the resulting disease states can dominate the clinical picture As with the classic manifestations of hypothyroidism, these unusual manifestations respond to thyroid hormone replacement therapy Thus, the importance of recognizing these signs and symptoms, as a result of hypothyroidism, is evident This article emphasizes these less common manifestations of the patient with hypothyroidism, and, in addition, discusses the possible pathophysiologic mechanisms by which thyroid hormone deficiency can lead to organ system dysfunction ( Arch Intern Med 1984;144:123-128)

Colonoscopy in asymptomatic individuals with a family history of colorectal cancer.

Abstract: • A prevalence screening program with colonoscopy was undertaken in four kindreds manifesting the cancer family [ill]yndrome. Forty-five percent of counseled patients underwent [ill]olonoscopy, providing 42 asymptomatic individuals. Seven [ill]atients (17%) were found to have adenomatous or villous [ill]olyps; two of these were malignant and one showed epithelial [ill]typia. Three of the seven patients with polyps had multiple [ill]sions. Only two patients had rectosigmoid polyps. From [ill]ese limited data, colonoscopy is recommended as a useful [ill]creening eening procedure in individuals at high risk for colorectal [ill]ancer. ( Arch Intern Med 1984;144:2209-2211)

Community-Acquired Bacteremic Pneumococcal Pneumonia: Effect of Age on Manifestations and Outcome

Abstract: • The cases of 38 hospitalized adults with community-acquired bacteremic pneumococcal pneumonia were evaluated prospectively to identify age-related differences in presenting features, clinical course, and outcome. Ten of 18 elderly patients (older than 65 years) were admitted from chronic care institutions v one of 20 younger adults. Coronary artery disease was more prevalent among the aged patients, and alcohol abuse and cigarette smoking were more common among the younger patients. All of the elderly persons and 90% of the younger had at least one serious underlying disorder. Older patients tended to report rigors and pleuritic chest pain less frequently than did the younger. Azotemia and roentgenographic evidence of multiple-lobe involvement were found more commonly in elderly persons. However, age-associated discrepancies were not observed in the duration of symptoms before admission, the prevalence of respiratory failure or metastatic infection, the interval between presentation and antibiotic administration, the duration of fever, the length of hospitalization, or the case fatality rates. Thus, the effects of advanced age on the manifestations and clinical course of community-acquired bacteremic pneumococcal pneumonia appear less pronounced than has been reported previously. ( Arch Intern Med 1984;144:945-948)

Management of oral anticoagulant therapy. Experience with an anticoagulation clinic

Abstract: • The experience acquired in an anticoagulation clinic during 4½ years is reviewed to demonstrate the effectiveness of such a clinic and to provide the practicing physician with guidelines for managing outpatient oral anticoagulation therapy. The experience is based on anticoagulant therapy in 141 patients during 1,264 patient-months. The patient population is characterized and aspects of management are explored, such as the incidence of major and minor complications (5% and 18% per treatment course, respectively), failure rate, and adequacy of therapy control. Guidelines concerning patient education, prothrombin time control, and other management suggestions are also given. This study, which compares favorably with others, is intended to aid the practicing physician and improve management of outpatient anticoagulation therapy. ( Arch Intern Med 1984;144:1966-1968)