Plasma heparin levels during and after hysterectomy with low-dose heparin or heparin-dihydroergotamin prophylaxis.

Abstract

<h2>Abstract</h2> Plasma heparin levels were determined using the chromogenic substrate S-2222, before, during and after hysterectomy in 226 patients given 5000 IU calcium heparin (Calciparin^R) or sodium heparin + 0.5 mg dihydroergotamin (DHE) (Heparin-Dihydergot^R) 12hourly,as prophylaxis. In 45 patients, diagnostic studies for deep vein thrombosis were carried out by the 125-Jod-fibrinogen-uptake-test. This was positive in 8 cases. 13 controls without surgery were each given 5000 IU of sodium heparin, calcium heparin, sodium heparin + 0.5 mg DHE, and DHE alone. When heparin levels were determined 3hourly, there was a significantly smaller increase three hours after the first injection (intraoperatively) than in controls without surgery. On the 4th day, the 3hourly levels were comparable to those on the day of surgery. On the 8th day they were a little higher, but still lower than in normal controls. The values just before the next injection of heparin/(DHE) were significantly decreased, compared to the starting ones, on the first and second postoperative day. This decrease was more marked in patients with a positive fibrinogen test. If 10 000 IU of heparin were infused continuously during the first 24 hours, the values remained constant on a slightly increased level. From the 3rd to the 8th postoperative day, the levels, 1 - 5 hours before the next injection of heparin/(DHE) did not differ from those before surgery. Heparin levels were similar during prophylaxis with Calciparin and with Heparin-Dihydergot. The slightly higher levels in patients with the combination of heparin + DHE were not found to be statistically different. It is concluded that low-dose heparin prophylaxis with 5000 IU heparin 12hourly with or without DHE can be given for eight days without the risk of accumulating heparin levels. The beneficial effect of DHE in prevention of deep vein thrombosis is not likely to be due to an influence on heparin kinetics. In high risk patients the continuous administration of 5000 IU of heparin per 12 hours is recommended during the first 24 to 48 hours after surgery.