Does dihydroergotamine potentiate the thromboprophylactic effect of dextran 70? A controlled prospective study in general and hip surgery

Author:

Bergqvist D1,Lindblad B1,Ljungström K-G2,Persson N H1,Hallböök T3

Affiliation:

1. Department of Surgery, Lunds Universitet, Allmänna Sjukhuset, Malmö, Sweden

2. Department of Surgery, Karolinska Institutet, Danderyds Sjukhus, Sweden

3. Department of Surgery, Kärnsjukhuset, Skövde, Sweden

Abstract

Abstract In a prospective randomized controlled study on postoperative thromboembolism, 259 patients undergoing elective general surgery, emergency general surgery, total hip replacement or hip fracture surgery were given thromboembolic prophylaxis with either a combination of dextran 70 and dihydroergotamine (DHE) or with dextran 70 alone. 500 ml dextran 70 was infused twice on the day of operation, once on postoperative days 1 and 3, and also on day 5 if the patient was still confined to bed. 0·5 mg DHE was given s.c. twice daily starting before operation and continued for 3 or 5 postoperative days. In hip fracture patients prophylaxis was started as soon as the diagnosis was made. 500 ml dextran 70 was given every other day before operation. DHE was given twice daily if so indicated from randomization. The patients were screened for deep-vein thrombosis (DVT) with the 125I-labelled fibrinogen test for 8 days and followed for one month postoperatively. In hip fracture surgery the incidence of DVT was significantly reduced by the combination of dextran 70 and DHE compared to dextran 70 alone (1/32 vs. 11/36, P = 0·003). However, this synergistic effect of DHE could not be detected in the other patient groups. Fatal pulmonary embolism did not occur. No severe side effects attributable to prophylaxis were noted in either group.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Reference38 articles.

1. Experimental use of macrodex as a prophylaxis against post-operative thrombo-embolism;Koekenberg;Bull Soc Int Chir,1962

2. Effect of dextran on postoperative thrombosis;Johnson;Acta Chir Scand,1968

3. Thromboembolism after elective and post-traumatic hip surgery - a controlled prophylactic trial with dextran 70 and low-dose heparin;Bergqvist;Acta Chir Scand,1979

4. Postoperative Thromboseprophylaxe durch Tonisierung des kaudalen Venensystems;Fey;Med Klin,1975

5. Efficacy of low-dose heparin in prevention of extensive deep-vein thrombosis in patients undergoing total-hip replacement;Sagar;Lancet,1976

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