Thromb Haemost 1994; 72(01): 016-020
DOI: 10.1055/s-0038-1648804
Original Article
Schattauer GmbH Stuttgart

Low Doses of Heparin and Heparin Dihydergot in Postoperative Thromboprophylaxis in Gynaecological Patients

Vera Urlep-Šalinović
The Department of Transfusiology and Immunohaematology, Teaching Hospital Maribor, Slovenia
,
Biserka Jelatancev
The Department of Transfusiology and Immunohaematology, Teaching Hospital Maribor, Slovenia
,
Borut Gorišek
1   The Department of Gynaecology, Teaching Hospital Maribor, Slovenia
› Author Affiliations
Further Information

Publication History

Received: 07 July 1993

Accepted after resubmission10 March 1994

Publication Date:
12 July 2018 (online)

Summary

A prospective study of postoperative thromboembolic prophylaxis involving 500 gynaecological patients was performed to compare the effectiveness and safety of low doses of heparin (LDH) and heparin-dihydergot (HDHE). In the LDH group 255 patients (51%) aged 26-84 were included, in the HDHE group there were 245 patients (49%) aged 34-86. Both groups were well matched with respect to risk factors, duration of surgery, type of operation, volume of blood transfused and duration of prophylaxis. Thromboembolism was detected in 48 patients (9.6%): 26 patients (10.2%) in the LDH group and 22 patients (9%) in the HDHE group. In the LDH group isotopic deep vein thrombosis (DVT) was found in 23 patients (9%), five of them had pulmonary embolism (PE), detected by lung perfusion scanning without clinical signs of PE, three patients developed clinical PE without detected DVT. In the HDHE group, 22 patients (9%) had isotopic DVT and five of them had PE detected by lung perfusion scanning. In the incidence of TE there was no statistically significant difference between the two groups (p >0.1). Within two months after surgery late clinically manifest TE confirmed by isotopic venography developed in five patients (1.9%) in the LDH group and in one patient (0.4%) in the HDHE group. Wound haematomas appeared in 8 patients (3.1%) in the LDH group and in 9 patients (3.7%) in the HDHE group. There were no ischemic complications (ergotism) in the HDHE group. The HDHE prophylaxis proved no more effective and was ten times more expensive than the usual prevention with LDH.

 
  • References

  • 1 Kakkar VV, Stringer MD, Hedges AR, Parker CJ, Welzel D, Ward VP, Sanderson RM, Cooper D, Kakkar S. Fixed combinations of low-molecular weight or unfractionated heparin plus dihydroergotamine in the prevention of postoperative deep vein thrombosis. Am J Surg 1989; 175: 413-418
  • 2 Farquharson DIM, Orr JW. Prophylaxis against thromboembolism in gynaecologic patients. J Reprod Med 1984; 29: 845-862
  • 3 Briel RC, Doller P, Hermann C, Hermann P. Thromboembolie - Prophylaxe bei Hysterektomien mit dem niedermolekularen Heparin-Fragmin. Geburtsh u Frauenheilk 1988; 40: 160-164
  • 4 Kakkar VV, Howe CT, Flanc C, Clarke MB. Natural history of postoperative deep-vein thrombosis. Lancet 1969; 2: 230-233
  • 5 Mavor GE, Galloway J. Iliofemoral venous thrombosis. Brit J Surg 1969; 56: 45-59
  • 6 Kakkar VV. Pathophysiologic characteristics of venous thrombosis. Am J Surg 1985; 150: 1-6
  • 7 Biland L, Zemp E, Widmar LK. Zur Epidemiologie der venosen Thromboembolie. Internist 1987; 28: 285-290
  • 8 Bounameaux H. Deep venous thrombosis: An overview. Vasa 1988; Suppl 25: 5-8
  • 9 Lowe GDO. Epidemiology of postoperative deep vein thrombosis and pulmonary embolism. Semin Thromb Hemost 1991; 17 (Suppl. 03) suppl 247-249
  • 10 Breddin KH. Thrombosis in Virchow’s triad: What is established. Semin Thromb Hemost 1989; 15: 237-239
  • 11 Kraemmer Nielsen H. Pathophysiology of venous thromboembolism. Semin Thromb Hemost 1991; (Suppl. 17) Suppl 3: 250-253
  • 12 Hamer JD, Malone PC, Silver IA. The P02 in venous valve pockets: it is possible bearing in thrombogenesis. Br J Surg 1981; 68: 166-170
  • 13 Comp PC. Overview of the hypercoagulable states. Semin Thromb Hemost 1990; 16: 158-161
  • 14 Clarke-Pearson DL, Jelovsek FR, Creasman WT. Thromboembolism complicating surgery for cervical and uterine malignancy: incidence, risk factors and prophylaxis. Obstet Gynecol 1987; 61: 87-94
  • 15 Kunz J, Briel RC, Drahne A. Das Thromboserisiko nach abdominaler und vaginaler Hysterektomie. Effektivitat und Praktikabilitat verschiedener Arten medikamentoser Prophylaxe. Geburtsh u Frauenheilk 1979; 39: 932-939
  • 16 Kakkar VV, Corrigan TP, Fossard DP. An international multicentre trial. Prevention of fatal postoperative pulmonary embolism by low doses of heparin. Lancet 1975; 1: 45-51
  • 17 Grgicevic D, Kovacic M, Pistotnik M, Radej M. Prevention of venous thromboembolism with low doses of heparin in urologic patients. Urology 1977; 9: 260-262
  • 18 Urlep-Salinovic V, Jelatancev B, Gorisek B. Prevention of postoperative thromboembolism in gynaecological malignancy. Eur J Gynaec Oncol 1993; 14: 63-67
  • 19 Coon WW. Anticoagulant therapy. Am J Surg 1985; 150: 45-49
  • 20 Perry MO. Anticoagulation: a surgical perspective. Am J Surg 1988; 155: 268-276
  • 21 Commerota AJ, Stewart GJ, White JV. Combined dihydroergotamine and heparin prophylaxis of deep vein thrombosis. Am J Surg 1985; 150: 39-44
  • 22 Duncan GG. Diseases of metabolism. Philadelphia: WB Saunders 1957: 993
  • 23 Sirridge MS, Shanon R. Laboratory evaluation of haemostasis and thrombosis. Philadelphia: Lea & Febiger 1983: 185-192
  • 24 Kakkar VV, Nicolaides AN, Renney JTG, Friend JR, Clarke MB. 125I fibrinogen test adapted for routine screening for deep vein thrombosis. Lancet 1970; 1: 540-542
  • 25 Blomback B, Carlson LA, Franzen S, Zetterquist E. Turnover of fibrinogen in man. Acta Med Scand 1966; 179: 557-574
  • 26 Kakkar VV. Fibrinogen uptake test for detection of deep vein thrombosis: a review of current practice. Semin Nucl Med 1977; 7: 229-244
  • 27 Gram J, Jespersen J. On the diagnosis of deep venous thrombosis in patients at risk. Dan Med Bull 1984; 31: 149-153
  • 28 Flanc C, Kakkar VV, Clarke MB. Detection of venous thrombosis of the legs using 125I labelled fibrinogen. Br J Surg 1968; 55: 742-747
  • 29 Kakkar VV. The diagnosis of deep vein thrombosis using the 125I fibrinogen test. Arch Surg 1972; 104: 152-159
  • 30 Becker J. The diagnosis of venous thrombosis in the legs using I-labelled fibrinogen: An experimental and clinical study. Acta Chir Scand 1972; 138: 667-681
  • 31 Heijboer H, ten Cate JW, Biiller HR. Diagnosis of venous thrombosis. Semin Thromb Hemost 1991; (Suppl. 17) Suppl 3: 259-268
  • 32 Endert G. Die kombinierte Radionuklidvenographie, Lungenperfusions-scintigraphie bei der Diagnostik venoser Thrombosen. Radioaktive Isotope in Klinik und Forschung 1978; 13: 619-695
  • 33 Yao JST, Henkin RE, Conn J, Quinn III JL, Bergan JJ. Combined isotope venography and lungscanning. New diagnostic approach to thromboembolism. Arch Surg 1973; 107: 146-151
  • 34 Henkin RE, Yao JST, Quinn III JL. et al Radionuclide venography (RNV) in lower extremity venous disease. J Nuclear Med 1974; 15: 171-175
  • 35 Webber MM, Poliak EW, Victery W, Cragin M, Resmick ZH, Grollman JH. Thrombosis detection by radionuclide particle (MAA) entrapment: Correlation with fibinogen uptake and venography. Radiology 1974; 111: 645-650
  • 36 Valhos L, MacDonald AF, Causer DA. Combination of isotope venography and lung perfusion scanning. Br J Radiol 1976; 49: 840-851
  • 37 Lensing AWA, Biiller HR, Prandoni P, Batchelor D, Molenaar AHM, Cogo A, Vigo M, Huisman PM, ten Cate JW. Contrast venography, the gold standard for the diagnosis of deep vein thrombosis: improvement in observer agreement. Thromb Haemostas 1992; 67: 8-12
  • 38 Lensing AWA, Hirsh J. 125I-fibrinogen leg scanning: Reassessment of its role for the diagnosis of venous thrombosis in post-operative patients. Thromb Haemostas 1993; 69: 2-7
  • 39 Clarke-Pearson DL, Coleman RE, Synan S, Hinshaw W, Creasman WT. Venous thromboprophylaxis in gynecologic oncology: A prospective, controlled trial of low dose heparin. Am J Obstet Gynecol 1983; 145: 606-613
  • 40 Nicolaides AN, Miles C, Hoare M, Jury P, Helmis E, Venniker R. Intermittent sequencial pneumatic compression of the legs and thromboembolism - deterrent stockings in the prevention of postoperative deep venous thrombosis. Surgery 1983; 94: 21-25
  • 41 Butterman G, Theisinger W, Weidenbach A, Hartung R, Welzel D, Pabst HW. Quantitative Bewertung der postoperativen Thromboembolieprophy-laxe. Med Klin 1977; 40: 1624-1638
  • 42 Schreiner WE. Perioperative Thromboembolie-Prophylaxe in der Gynako-logie. Arch Gynaecol 1986; 239: 137-147
  • 43 Adolf J, Buttermann G, Weidenbach A, Gmeineder F. Optimierung der postoperativen Thromboseprophylaxe in der Gynaekologie. Geburtsh u Frauenheilk 1978; 38: 98-104
  • 44 DiSerio FJ, Sasahara AA. United States trial of dihydroergotamine and heparin prophylaxis of deep vein thrombosis. Am J Surg 1985; 150: 25-32
  • 45 Multicenter trial Committee. Dihydroergotamine-heparin prophylaxis of postoperative deep vein thrombosis. A multicenter trial. JAMA 1984 251. 2960-2966
  • 46 Hohl MK, Liischer KP, Annaheim M, Fridrich R, Gruber UF. Dihydroergotamine and heparin or heparin alone for the prevention of postoperative thromboembolism in gynaecology. Arch Gynecol 1980; 230: 15-19
  • 47 Buttermann G, Haluszczysnki I, Theisinger W, Pabst HW. Postoperative Thromboembolie-Prophylaxe mit reduziertem low-dose Heparin-Anteil und Dihydroergotamin in fixer Kombination. Munch med Wschr 1981; 123: 1213-1216
  • 48 Clagett GP, Reisch JS. Prevention of venous thromboembolism in general surgical patients. Results of meta-analysis. Ann Surg 1988; 208: 227-230
  • 49 Rickies FR, Edwards RL. Activation of blood coagulation in cancer: Trousseau’s syndrome revisited. Blood 1983; 62: 14-31
  • 50 Fricker JP, Vergnes Y, Schach R, Heitz A, Eber M, Griinebaum L, Wiesel ML, Kher A, Barbier P, Cazenave JP. Low dose heparin versus low molecular weight heparin (Kabi 2165, Fragmin) in the prophylaxis of thromboembolic complications of abdominal oncological surgery. Eur J Clinic Invest 1988; 18: 561-567
  • 51 Van Ooijen B. Subcutaneous heparin and postoperative wound haema-tomas. Arch Surg 1986; 121: 937-940
  • 52 Baertschi U, Schaer A, Bader P, Huber L, Morf P. Thromboseprophylaxe nach gynakologischen Operationen: Eine Vergleichsstudie von Low-Dose-Heparin und oralen Anokoagulantien. Geburtsh u Frauenheilk 1975; 35: 754-760
  • 53 Pedersen B, Christiansen J. Thromboembolic prophylaxis with dihydroergotamine heparin in abdominal surgery. Am J Surg 1983; 145: 788-790
  • 54 Kakkar VV, Spindler J, Flute PT, Corrigan T, Fossard DP, Crellin RQ. Efficacy of low doses of heparin in prevention of deep vein thrombosis after major surgery. Lancet 1972: 101-106
  • 55 Schmitz-Huebner U. Prophylaxe der venosen Thromboembolie. Dtsch Med Wschr 1986; 111: 906-908
  • 56 Emory CE, Cuddy PG. Should dihydroergotamine-heparin be used for prevention of postoperative thromboembolism. Drug Intell Clin Pharm 1987; 21: 427-431
  • 57 Kakkar VV. Ergotism and heparin-dihydroergotamine. Lancet 1982; 2: 96-97
  • 58 Gatterer R. Ergotism as complication of thromboembolic prophylaxis with heparin and dihydroergotamine. Lancet 1986; 638-639
  • 59 Blanke H, Leschke M, Strauer BE. Heparin-induzierte Thrombopenie. Dtsch Med Wschr 1987; 112: 96-99
  • 60 Kelton J. Heparin induced thromboctopenia. Haemostasis 1986; 16: 173-186