DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

 

PUBLIC HEALTH SERVICE BETHESDA 14, MD.

 

NATIONAL INSTITUTES OF HEALTH

July 5, 1957

Dear Mr. Fogarty:

Your letter with the attached inquiry from Mrs. Charles
R. Capace has been carefully reviewed by members of the
Heart Institute staff,

Dicumarol and other similar anticoagulants are important
new weapons in the physician's medicine cabinet. The American
Heart Association has specifically advised the use of anticoagu-
lants in patients suffering from congestive heart failure (dropsy)
and in patients who have recently suffered myocardial infarctions
(coronary thromboses). One of the common ways of administering
these drugs is a daily dose schedule over an indefinite period of
time, the length of treatment being determined by the physician,
specific for individual patient's condition, rather than by any set
rule,

For the medical profession as a whole there are some
unsettled questions. There are many physicians who believe its
use should be confined to certain carefully selected cases. There
is general agreement that such drugs should not be used unless
the physician can see the patient at regular intervals and has
available the laboratory facilities which will allow careful evaluation
and control of the anticoagulant effect.

A physician who is not acquainted with the details of a
case may speak in generalities, but very often such generaliza-
tions are not applicable to a specific case. Thus, it is difficult
to offer a considered opinion unless one knows the clinical details

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concerning the patient and any heart attack the patient has
experienced, It is equally difficult for a non-medical person
to gain sufficient understanding to serve as a basis for such

a decision. The only logical approach to such a problem is
to place the patient in the care of an experienced and capable
physician and follow his advice. The patient and his family
must have complete confidence in the physician's recommenda-
tions.

I hope that this information will be helpful in answering
Mrs. Capace's questions. If’ we can be of any further assistance,
please do not hesitate to call on me,

Sincerely yours,

EE in tay CL MOREE
James Watt, M.D.
Director
National Heart Institute

  
 

Hon, John E. Fogarty
House of Representatives

Enclosures