Summary and conclusionsA total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin.Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 lowdose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis.There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.

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We have evaluated the incidence of bleeding complications using miniheparin (2 X 2500 IU daily)-dihydroergotamine starting preoperatively in a randomized, controlled, prospective, double-blind study in 50 patients undergoing herniated lumbar disc operations. There was no difference in the incidence of intraoperative bleeding problems between the two groups. Preoperatively, 13 patients have been treated in another hospital with conventional low-dose heparin, and of these 13 patients, 7 developed bleeding complications. There were two deep wound hematomas in the placebo group. Early removal of stitches or operative revision of the wound was not necessary in either group. We conclude that the use of minidose heparin-dihydroergotamine is feasible for the prevention of thromboembolic complications in patients undergoing herniated lumbar disc operations, since an increased incidence of bleeding complications was not observed. This preventive method should therefore be further clinically evaluated.

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