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The clinical results in 100 patients treated for thromboembolic disorders were compared with 100 similar patients treated with Dicumarol. The rate of induction, ability to maintain a constant therapeutic level, and duration of action were especially considered. Induction and maintenance dosage were determined by clinical trial. SINCE the introduction of Dicumarol intoclinical usage in 1942, the efficacy of anticoagulant therapy for the treatment of thromboembolic disorders has been well established. The search for more efficient prothrombin depressants has continued and the clinical usefulness of many such drugs has been investigated. Those that have been found acceptable thus far have all been either coumarin or indanedione derivatives. It is the purpose of this paper to report 1 year's experience with a new derivative of the coumarin series, nitrophenyl-acetyl-ethyl-4-oxycoumarin. This drug is known commercially as Sintrom.*The mode of action and metabolism of Sintrom have been thoroughly studied by European workers and they have found that its main action is to depress factor VII and to a lesser extent prothrombin, early in the course of treatment.' Both are equally affected after several weeks of treatment.2 It disappears from the body rapidly but unlike ethyl biscoumacetate (Tromexan), which is metabolized to an inactive acid form, Sintrom is chiefly excreted unaltered.3-5 Preliminary clinical studies indicated that Sintrom is intermediate in action between Tromexan and Dicumaroll-3 5-9 and suggested that it has certain advantages over both of them. Other workers'0-12 in this field have listed the qualities of an ideal anticoagulating agent and it is generally agreed that, could these criteria be met, the clinical application and safety of these drugs would be increased. We consider the following to be the most important qualities that a drug of this type should possess: 1. It should rapidly lower the activity of the prothrombin complex to a therapeutic range. 2. It should maintain its effect long enough to prevent fluctuations of prothrombin levels when the drug is administered in single daily doses. 3. It should be metabolized or excreted quickly enough to permit a rapid recovery of the prothrombin complex on cessation of therapy. 4. Its effect should be rapidly counteracted by the administration of a suitable pharmacologic antagonist. 5. The doses should be relatively constant in a given patient and from patient to patient. 6. It should be effective when administered orally. 7. It should be nontoxic and well tolerated in therapeutic dosages. With these factors in mind a clinical study was undertaken at the Pennsylvania Hospital to evaluate the efficacy of Sintrom as an anticoagulant and to compare it with other coumarin drugs.METHODS AND MATERIALS During the period of this study 156 patients with thromboembolic disorders received Sintrom. These cases were unselected and consisted of all patients admitted during this period who required anticoagulant therapy. Those cases with thrombophlebitis, pulmonary e...