[Complications of thromboembolic prophylaxis with heparin-dihydroergotamine]

In a prospective study the complications of Heparin-Dihydroergotamine (HDHE) [2,500 units Heparin + 0.5 mg DHE] s c. twice daily as thromboembolic prophylaxis have been studied in patients undergoing a lumbar disc operation. During a two year period 616 patients were operated, 47 patients had to be excluded, 107 patients did not receive HDHE desired by the surgeon; 462 patients received HDHE as described in the protocol. Because the distribution of age, sex, duration of hospitalisation of the 107 patients without HDHE is the same as in the HDHE group, this group can be used as control group. Increased intraoperative bleeding--written down in the operation report--66 patients (14.3%) in HDHE group and 6 patients (5.6%) in the control group. There is no statistic significance between the both groups in superficial and deep wound hematomas, deep vein thromboses or pulmonary embolism. In the HDHE group two death appears. Both patients [a 37 year old, asymptomatic woman and a 65 year old man with mild ischemic symptoms 11 months prior to operation] died because of an acute myocardial infarction. The clinical course and the missing of stenosis or occlusion at autopsy let us think at the possibility of coronary arterial spasm, presumably caused by DHE, as the cause of myocardial infarction. We suggest not to apply HDHE to patients with coronary artery heart disease or with atypical thoracic pain.