The Effect of 3,3′-Methylene-Bis-(4-Hydroxycoumarin) (Dicumarol) on the Prothrombin and Coagulation Times of Blood

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In July 1942 the results of the use of dicumarol in 23 patients reported.1 Since that time the drug has been administered to 70 additional patients, making a total of 93. After the article of Butt, Allen, Bollman2 on the administration of dicumarol in man numerous appeared. These were summarized by Gefter, Kramer, and Reinhold3 in 1944 in a comprehensive review of the literature and a report of cases of thromboembolic disease in which the preparation was used.

Clinical conditions for which dicumarol was administered. The table classifies conditions for which dicumarol was administered at Cleveland Clinic up to March 1945. The largest group consisted acute superficial thrombophlebitis. These cases were differentiated those of deep thrombophlebitis because the degree of clinical response seemed to vary. The second largest group consisted of cases of thrombosis involving the vein or artery. The remaining cases were postoperative pulmonary embolus, thromboangiitis obliterans, coronary thrombosis with infarction of the myocardium, and peripheral thrombosis, either secondary to heart disease or caused by arteriosclerosis obliterans (table).

Method of administration. The administration of dicumarol presents an interesting but difficult problem. Various methods have been proposed. Meyer, Bingham, and Pohle4 recommended an initial dose of 5 mg. per kilogram body weight followed by 1/5 to 1 mg. per kilogram daily. Among others Gefter, Kramer, and Reinhold3 used this method in their series of 30 cases. My clinical experience, however, showed that this method of administration was difficult to control, inasmuch as the effect of dicumarol is cumulative, and maximum. . .



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