Vascular spasm and gangrene during heparin-dihydro-ergotamine prophylaxis

A case is reported of a multiple trauma victim who developed severe vascular spasm whilst receiving heparin–‐dihydro‐ergotamine thrombo‐embolic prophylaxis which ultimately led to amputation of the right foot. Identification of high risk groups for this complication is attempted from a review of the literature. Treatment should be with intra‐arterial or intravenous nitroprusside or nitrates. Little information is as yet available on the use of prostacyclin in this condition.