Prevention of postoperative thromboembolism in gynaecological malignancy

A prospective randomized clinical trial compared the efficacy of low doses of heparin (LDH) and heparin plus dihydroergotamine mesylate (HDHE) in the prevention of thromboembolism in gynaecological patients with malignancy undergoing major surgery. One hundred and fifty-five patients, with a mean age 54.5 years were allocated to receive 5,000 IU unfractionated heparin or 5,000 IU unfractionated heparin +0.5 mg dihydroergotamine mesylate twice daily. Treatment was begun 2 hours preoperatively and continued until discharge (12 +/- 7 days). The incidence of thromboembolism determined by radiolabelled fibrinogen and lung perfusion scanning was 21.3% in LDH group and 22.7% in HDHE group. There were no statistically significant differences between the two groups (p > 0.1). The observed haemorrhagic rate was 1.9% in both groups. HDHE prevention was more expensive but without significant advantage over LDH. During two months after surgery 4 patients (5%) in the LDH group and 1 patient (1.8%) in the HDHE group developed deep vein thrombosis.