The effect of librium on hemostasis

Unrecognized pulmonary embolism presenting as disseminated intravascular coagulation

Six patients are described in whom disseminated intravascular coagulation of uncertain cause was found to be due to occult pulmonary embolism. The peripheral blood smear showed thrombocytopenia in all patients and schistocytes in four. Coagulation studies revealed increased levels of fibrinogen/fibrin degradation products (six of six patients), positive results for fibrin monomer (five patients), prolonged thrombin times (four patients), hypofibrinogenemia (three patients), prolonged prothrombin times (two patients), and decreased plasma coagulation factors (two patients). Pulmonary embolism was confirmed by lung scanning or pulmonary angiography. Institution of full-dose heparin therapy was associated with hemostatic and clinical improvement in all patients. The association of disseminated intravascular coagulation with occult pulmonary embolism merits recognition since full-dose heparinization is required for successful therapy.

[The influence of diazepam (valium) on the effect of phenprocoumon (marcumar) (author's transl)]

In 10 patients who were treated with phenprocoumon (Marcumar) for thrombembolic diseases, we examined the influence of the combined therapy with diacepam (Valium) on the effect of the anticoagulant. After stopping the therapy with diacepam we saw a significant increase of the prothrombinetime (Quick) beyond the therapeutic level of 25%. By increasing the dosis of phenprocoumon the therapeutic level was achieved again not until after 8 days. The dosis needed for maintaining this level was on the average 32% higher than during the time of the therapy in which diacepam was used. Because of the increased thrombembolic risk, when going beyond the therapeutic level of the prothrombinetime, this interaction is of clinical importance.

Interactions of benzodiazepines with warfarin

Administration of nitrazepam (10 mg nightly), diazepam (15 mg/day), and chlordiazepoxide (15 and 30 mg/day) had no effect on steady-state plasma warfarin concentrations, the plasma half-life of warfarin, or anticoagulant control in patients and it appears safe to prescribe these agents to patients on long-term oral anticoagulants. Urinary excretion of 6 beta-hydroxycortisol, however, increased in two out of five patients given chlordiazepoxide. In rats pretreatment with chlordiazepoxide (40 mg/kg for four days) caused stimulation of liver microsomal enzyme activity but neither diazepam nor nitrazepam had this effect.

Psychopharmacologic management of anxiety in the cardiac patient

Of 253 patients who had suffered acute myocardial infarction ( MI), 88 percent received daytime sedation while hospitalized. Sixty percent of all prescriptions were for phenobarbital, 30 percent for chlordiazepoxide, and 6 percent for meprobamate. In addition, 79 percent of patients received night time hypnotic medication. Sixty-six percent of such prescriptions were for short-acting barbiturates, 21 percent for chloral hydrate, and 7 percent for diphenhydramine. Multiple drug use was common.

The barbiturates, while inexpensive sedative agents, are of questionable efficacy in reducing anxiety and probably produce only general CNS depression. A narrow margin of safety, liability to produce habituation, and antagonism of warfarin-type anticoagulants are other disadvantages. The benzodiazepine tranquilizers, whose antianxiety efficacy is more clearly established, do not produce general CNS depression, have a wide margin of safety, and do not interact with oral anticoagulants.

Antidepressant agents, phenothiazine tranquilizers, and propranolol were used infrequently or not at all. The risks associated with the use of these agents in patients with acute myocardial infarction are considerable and should be weighed carefully before they are administered.