Should Dihydroergotamine-Heparin be used for Prevention of Postoperative Thromboembolism?

Ce, Emory; Pg, Cuddy

doi:10.1177/106002808702100505

Cited by 2 publications

(2 citation statements)

References 19 publications

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“…In the HDHE group the prophylaxis was discontinued due to abdominal cramps in one patient, other side effects of DHE were not observed in our patients. Ergotism was rare in other studies and appeared in about 2.3% of patients (56)(57)(58). In our patients heparin-induced thrombocytopenia was not present.…”

Section: Discussionsupporting

confidence: 49%

Low Doses of Heparin and Heparin Dihydergot in Postoperative Thromboprophylaxis in Gynaecological Patients

1994

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SummaryA prospective study of postoperative thromboembolic prophylaxis involving 500 gynaecological patients was performed to compare the effectiveness and safety of low doses of heparin (LDH) and heparin-dihydergot (HDHE). In the LDH group 255 patients (51%) aged 26-84 were included, in the HDHE group there were 245 patients (49%) aged 34-86. Both groups were well matched with respect to risk factors, duration of surgery, type of operation, volume of blood transfused and duration of prophylaxis. Thromboembolism was detected in 48 patients (9.6%): 26 patients (10.2%) in the LDH group and 22 patients (9%) in the HDHE group. In the LDH group isotopic deep vein thrombosis (DVT) was found in 23 patients (9%), five of them had pulmonary embolism (PE), detected by lung perfusion scanning without clinical signs of PE, three patients developed clinical PE without detected DVT. In the HDHE group, 22 patients (9%) had isotopic DVT and five of them had PE detected by lung perfusion scanning. In the incidence of TE there was no statistically significant difference between the two groups (p >0.1). Within two months after surgery late clinically manifest TE confirmed by isotopic venography developed in five patients (1.9%) in the LDH group and in one patient (0.4%) in the HDHE group. Wound haematomas appeared in 8 patients (3.1%) in the LDH group and in 9 patients (3.7%) in the HDHE group. There were no ischemic complications (ergotism) in the HDHE group. The HDHE prophylaxis proved no more effective and was ten times more expensive than the usual prevention with LDH.

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Section: Discussionsupporting

confidence: 49%

Low Doses of Heparin and Heparin Dihydergot in Postoperative Thromboprophylaxis in Gynaecological Patients

1994

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“…Yet 29% of Swedish (12) and Danish (13) orthopaedic surgeons surveyed in 1987/88 and 1990 reported they use this combination. A relatively expensive formulation combining heparin with DHE was withdrawn from the North American market (14) but the components remain separately available there and elsewhere.…”

mentioning

confidence: 99%

Apparent Lack of Synergism between Heparin and Dihydroergotamine in Prevention of Deep Vein Thrombosis after Elective Hip Replacement: a Randomised Double-Blind Trial Reported in Conjunction with an Overview of Previous Results

et al. 1992

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SummaryWe report the results of a double-blind, randomised trial of venous thrombosis (VT) prevention in 117 patients having elective hip replacement where low dose heparin alone (5,000 IU sodium heparin given subcutaneously [sc] 8 hourly until the seventh postoperative day) was compared with low dose heparin plus dihydroergotamine (DHE; 0.5 mg, given 8 hourly by sc injection). The trial end point consisted of VT discovered through bilateral ascending venography done routinely on the seventh postoperative day. VT developed in 34% of patients given heparin/DHE (95% confidence interval = 22% – 47%) compared with 24% in those given low dose heparin alone (95% confidence interval = 14% – 37%; p = 0.34), difference = 10% (95% confidence interval = –7% to +26%). Corresponding figures for the incidence of proximal (above-knee) thrombosis were 17% and 14% (95% confidence intervals = 8% – 29% and 6% – 25% respectively). These results are discussed in the context of a detailed overview of published evidence concerning VT prevention with heparin/DHE after hip replacement and we conclude it is unlikely that heparin/DHE is markedly superior to low dose heparin alone in this clinical setting.

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Should Dihydroergotamine-Heparin be used for Prevention of Postoperative Thromboembolism?

Cited by 2 publications

References 19 publications

Low Doses of Heparin and Heparin Dihydergot in Postoperative Thromboprophylaxis in Gynaecological Patients

Low Doses of Heparin and Heparin Dihydergot in Postoperative Thromboprophylaxis in Gynaecological Patients

Apparent Lack of Synergism between Heparin and Dihydroergotamine in Prevention of Deep Vein Thrombosis after Elective Hip Replacement: a Randomised Double-Blind Trial Reported in Conjunction with an Overview of Previous Results

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