Prophylaxis of Postoperative Thromboembolism with Heparin-Dihydroergotamine Combination

Abstract

The effect and safety of a fixed combination — 5000 iu of heparin + 0.5 mg of dihydroergotamine every 12 h subcutaneously (HDHE) versus 5000 iu of heparin every 8 h subcutaneously (LDH) for prophylaxis of postoperative venous thromboembolism was evaluated in a prospective randomized clinical trial involving 142 patients undergoing major abdominal surgery. Using the radiofibrinogen uptake test postoperative deep venous thrombosis was detected in 10% of 70 patients in the HDHE group and in 14% of 72 patients of the LDH group. Seven patients died. Neither fatal, nor contributory pulmonary emboli were found at autopsy. Pulmonary microembolism diagnosed with lung perfusion scintigraphy and chest radiography developed in three patients treated with LDH and in one patient treated with HDHE. Significantly more wound haematomas and injection site bruises were observed in the LDH group. The conclusion drawn was that the 12-hourly regimen of heparin with DHE was as effective in preventing venous thromboembosis as the 8-hourly heparin regimen. The lowering of the heparin dose significantly reduced both the number of wound haematomas and injection site bruising.