Preventing pulmonary embolism with heparin in low doses

Combination dihydroergotamine mesylate and heparin sodium with lidocaine HCl. Pharmacokinetics, mechanism of action, clinical efficacy, and adverse effects

Dihydroergotamine(DHE)-heparin combination offers a unique treatment modality for the prevention of deep vein thrombosis. The combination appears to affect all 3 limbs of Virchow's triad: hypercoagulability, venous stasis, and endothelial damage. In most efficacy studies, data indicated that the combination of DHE 0.5 mg and heparin 5000 IU was superior to low-dose heparin alone. Even when the efficacy of DHE-heparin was the same as that of heparin alone, the use of the combination allowed for a decrease in the heparin dose required.

Complications of acute respiratory failure

Acute respiratory failure is frequently fatal. Attempts to decrease mortality must include attention to pulmonary and extrapulmonary complications. Pulmonary complications include pulmonary emboli, barotrauma, fibrosis, and pneumonia. Swan-Ganz catheters, tracheal intubation, and mechanical ventilation can also result in pulmonary complications. Extra-pulmonary complications such as gastrointestinal hemorrhage, renal failure, infection, and thrombocytopenia may increase mortality. Early diagnosis, aggressive treatment, and prophylaxis of complications should increase survival.

Prevention of pulmonary emboli in a respiratory intensive care unit: efficacy of low-dose heparin

Ninety-eight patients admitted to our respiratory intensive care unit during a one-year period were compared retrospectively with 99 well-matched patients admitted during a second one-year period. The use of prophylactic low-dose heparin in the second year was associated with a significant decrease in pulmonary emboli documented by ventilation-perfusion scan, pulmonary angiography, and autopsy. No specific bleeding complications could be directly attributed to the use of low-dose heparin. The frequency and severity of gastrointestinal hemorrhage as determined by hemoglobin fall and transfusion requirements were not significantly affected by the prophylactic use of low-dose heparin. Low-dose heparin appears to be effective and safe in respiratory intensive care unit patients in the prevention of pulmonary emboli.

The use of prophylactic low dose heparin in transurethral prostatectomy

Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.