Dihydroergotamine and the thromboprophylactic effect of dextran 70 in emergency hip surgery

In a prospective randomized controlled trial treatment with a combination of dextran 70 and dihydroergotamine (DHE) was compared with the administration of dextran 70 alone as prophylaxis against postoperative thrombo‐embolic complications in emergency hip surgery. Forty‐five consecutive patients with a fractured hip entered the study. Twenty‐one were randomized to prophylactic treatment with dextran 70 (group 1) and twenty‐four patients received dextran 70 and DHE (group 2). Both regimens were initiated pre‐operatively and the surgical and postoperative procedures were the same in the two groups. On the first and fourth postoperative day, Tc‐plasmin scintigraphy of the lower extremities and pulmonary ventilation/perfusion scintigraphy were performed to detect any deep vein thrombosis (DVT) and/or pulmonary emboli. A total of 19 per cent of group 1 patients developed DVT and so did 25 per cent in group 2; this difference was not statistically significant. Of the detected DVT, 60 per cent were subclinical, and 7 per cent of the patients had minor pulmonary emboli, all of which were symptomless. No therapeutic difference could be demonstrated between the two regimens. A recent report claiming that adding DHE to the prophylactic administration of dextran 70 considerably reduces the incidence of postoperative DVT in emergency hip surgery is questioned.