Prevention Of Fatal Postoperative Pulmonary Embolism With Heparin-Dhe Or Dextran

Abstract

Previous trials studying prevention of postoperative fatal pulmonary embolism (p.e.) concern elective general surgery. We have terminated a prospective, randomized multicentre trial comparing the effectiveness of s.c. heparindihydroergotamin (DHE) versus i.v. dextran in surgery of the musculoskeletal system including both emergency and elective cases. 14 Swiss hospitals participated. All adults operated upon were included and followed up for 6 weeks. 5000 IU heparin together with 0.5 mg DHE were given preoperatively and 12-hourly thereafter for at least one week. Patients in the dextran group received 6% dextran 70 in saline, a total of 3 × 500 ml. 8001 patients were admitted to the trial and 7413 fulfilled the criteria of the study. 5963 patients had been operated electively, 1450 as an emergency. 4368 patients had general anesthesia, 2259 were operated upon under epidural and 797 had other anesthetic procedures. 55 patients died during the first 6 postoperative weeks, the autopsy rate being 69%. 9 patients in the dextran group died of p.e. In 6 cases the pathologist decided the pulmonary embolus as being the only cause of death, in 3 the embolus was considered a contributory cause of death. In the heparin-DHE group 6 patients died of p.e. In 4 cases the embolus was the sole cause of death, in 2 it was contributory. These differences in the incidence of p.e. are statistically not significant. There were however significantly more bleeding and allergic complications in the dextran than in the heparin-DHE group.Conclusion: Both s.c. heparin-DHE and i.v. dextran are equally effective for the prevention of fatal pulmonary embolism. Heparin-DHE causes less bleeding complications.