Prevention of fatal postoperative pulmonary embolism by heparin dihydroergotamine or Dextran 70

Abstract

Abstract Eight thousand and one patients were admitted to a prospective, randomized multicentre trial comparing the prophylactic efficacy of heparin-dihydroergotamine (DHE) and Dextran 70 against fatal pulmonary embolism after emergency or elective orthopaedic surgery. Of the 7413 patients correctly admitted to the trial, 3698 were allocated to receive heparin-DHE and 3715 to receive Dextran 70. Twenty-eight patients in the heparin-DHE and 27 in the dextran group died within 40 days of operation. Necropsy was performed in 19 cases in each group. In 6 patients in the heparin-DHE and in 9 in the dextran group pulmonary embolism was the sole or a contributory cause of death (n.s.). In the dextran group there were more diffuse intraoperative bleeding complications (P < 0·01), more massive postoperative haemorrhages (P < 0·01), more small wound haematomas (P < 0·05) and more allergic reactions (P < 0·05). This is the first large multicentre trial dealing with elective and emergency procedures in orthopaedic patients.