Assessment Of Venous Function After Major Gynecological Surgery With Heparin-Dihydroergotamine In The Prophylaxis Of DVT

Abstract

Dihydroergotamine (DHE) has been shown to have synergistic effects with heparin in the prophylaxis of DVT. To assess the hemodynamic efficacy of DHE in clinical conditions, 72 patients undergoing hysterectomy were randomly allocated to three groups receiving heparin/DHE, heparin or acenocoumarol. Venous function was measured by occlusion plethysmography and doppler ultrasonography. Diagnosis of DVT by 125-I-fibrinogen test.Results: Doppler Ultrasonography: The velocity of venous flow in the left V. femoralis was lower than at the right side in all groups before hysterectomy. After surgery, a significant increase from 11.2 to 15.5 cm/sec in the heparin/DHE group could be demonstrated. Heparin and acenocoumarol patients showed a tendency to lower venous return. The differences were more marked in women with vaginal hysterectomy.Occlusion plethysmography: No differences in venous capacity before and after operation could be found in the heparin and acenocoumarol group. A significant reduction (16%) was measured in heparin/DHE treated patients. The maximal venous outflow also was significantly reduced in this group (18%). This difference also was found in patients with varicose veins.Conclusions: The data confirm that DHE increases the velocity of venous blood flow in the legs by constricting the capacitance vessels. This haemodynamic effect could be demonstrated in clinical conditions.