Emory C E, Cuddy P G
Drug Intell Clin Pharm. 1987 May;21(5):427-31. doi: 10.1177/106002808702100505.
The combination of heparin 5000 U and dihydroergotamine 0.5 mg (HDHE) was marketed in the U.S. in 1985 for prophylaxis of postoperative deep venous thrombosis (DVT). This article evaluates the efficacy, safety, and cost of HDHE for abdominal, pelvic, thoracic, and total hip surgical prophylaxis. Although several controlled trials comparing HDHE to minidose heparin (MDH) indicate superior efficacy of HDHE for nonorthopedic surgical procedures, others do not. Differences in study design and insufficient sample sizes may account for the dichotomy. In the U.S. Multicenter Trial, MDH was surprisingly ineffective for preventing radiofibrinogen uptake test-proven DVT. The apparent superiority of HDHE over MDH is therefore questionable. Ergot-related side effects have been minimized in all studies due to careful patient selection. In actual use, the potential for such side effects appears to be increased. Because twice-daily HDHE is no more effective, costs 4-11 times more, and may pose a greater risk than MDH, the authors do not recommend its use for general surgical prophylaxis. HDHE may prove to be useful in patients undergoing total hip replacement.
肝素5000单位与双氢麦角胺0.5毫克的组合（HDHE）于1985年在美国上市，用于预防术后深静脉血栓形成（DVT）。本文评估了HDHE用于腹部、盆腔、胸部及全髋关节手术预防的疗效、安全性和成本。尽管多项将HDHE与小剂量肝素（MDH）进行比较的对照试验表明，HDHE在非骨科手术中疗效更佳，但其他试验结果并非如此。研究设计的差异和样本量不足可能是造成这种分歧的原因。在美国多中心试验中，MDH在预防经放射性纤维蛋白原摄取试验证实的DVT方面出人意料地无效。因此，HDHE相对于MDH的明显优势值得怀疑。由于精心挑选患者，在所有研究中与麦角相关的副作用已降至最低。在实际使用中，此类副作用的可能性似乎有所增加。由于每日两次使用HDHE并不更有效，成本高出4至11倍，且可能比MDH带来更大风险，作者不建议将其用于一般外科预防。HDHE可能对接受全髋关节置换术的患者有用。
