Refractory vasospasm occurring in a trauma patient receiving dihydroergotamine and heparin

A case of severe vasospasm producing ischemia associated with the administration of dihydroergotamine and heparin for prophylaxis of deep venous thrombosis is presented. We feel that the intensity of the vasospasm was related to the ergot in combination with the use of pressors and the presence of an operative site contiguous to the spastic artery. Based on our experience and a review of the world's literature, we feel that risk of vasospasm in trauma patients outweighs the potential additional benefit of this combination of drugs over heparin prophylaxis alone.