Pulmonary embolism following anticoagulation therapy

Five patients with traumatic spinal injury received a course of oral anticoagulant therapy with warfarin, heparin, or phenindione for 90 days following injury. These patients, on discontinuation of anticoagulant therapy, developed pulmonary embolus; two of these were confirmed by ventilation perfusion lung scintigraphy, and two were confirmed at post-mortem. The reasons for this are discussed, in particular the importance of delayed anticoagulation, obesity, operations, and mobilization in wheelchairs. The implications for further treatment are discussed.