Two hundred and five patients scheduled for total hip alloplasty were randomized to one of the following two regimes, in order to prevent postoperative thromboembolism. (1) Graded compression stockings and heparin 5000 iu/dihydroergotamine 0.5 mg twice a day subcutaneously. (2) Graded compression stockings and placebo twice a day subcutaneously. Screening for deep venous thrombosis (DVT) was carried out by 99mTc-plasmin scintimetry and whenever this was indicative for DVT, ascending phlebography was performed. The definitive criteria for DVT were intraluminal filling defects on phlebography. If DVT was diagnosed, pulmonary perfusion/ventilation scintigraphy was performed. In the group receiving heparin/dihydroergotamine 11 of 96 patients (11%) developed DVT and in the placebo group 25 of 109 patients (23%) developed DVT (P < 0.05). One patient in the combination treatment group and seven patients in the placebo group developed pulmonary embolism ( P < 0.05). It is concluded that the combination of graded compression stockings, low dose heparin and dihydroergotamine is superior to graded compression stockings alone in preventing thromboembolism following total hip alloplasty.
Intermittent pneumatic compression to prevent proximal deep venous thrombosis during and after total hip replacement
