E • COMPLICATIONS
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continued as maintenance dose for at least 36 hours after the treatment is continued by
Dindevan therapy. Once oral anticoagulation by Dindevan has been commenced, its
effect becomes apparent only after 2 days. The initial and maintenance dose of Dindevan
varies according to the patient's condition and age, but an initial dose of 200 mg on the
first day, 100 mg on the second day and thereafter determined by the control prothrombin
efficiency test is the usual routine.
As prophylactic treatment Dindevan is used alone with an initial dose of 100 mg
orally followed by 75 mg. Continuous control is essential. This therapy should never be
discontinued abruptly.
The risks of the anticoagulant therapy are haemorrhages which may develop in
various organs. In 1963 a case of haematuria has been reported (Guttmann, 1963) and
two more cases of haematuria occurred later at Stoke Mandeville. In one case, uterine
haemorrhage occurred in a woman who had a fibroid tumour. Harris (1965) reported 3
cases of spinal epidural haemorrhage with a rapid progressive paraparesis in patients who
had anticoagulant therapy for other reasons, in particular cardiac disease.
Antidote to overdosage of anticoagulants is vitamin K, in doses of 5-20 mg orally.
Toxic side effects of Dindevan, which include skin rashes pyrexia, diarrhoea are
uncommon. In case of idiosyncrasy to Dindevan, a change over to another anticoagulant
is indicated, such as Marevan (Warfarin sodinin Evans).
Anticoagulant therapy is contraindicated in existing bleeding such as haemothorax,
gastric or duodenal ulcer, associated head injury, severe renal or liver disease and
uncontrolled hypertension.
