ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04023.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

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 req

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04024.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Venous thromboembolic disease contributes to morbidity and mortality in certain groups of hospitalized patients, particularly those who have undergone surgery. Although principles of treatment have changed relatively little during the past 20 years, significant advances have been made in the diagnosis of deep vein thrombosis (DVT). Venography, once the only reliable diagnostic technique, has been largely replaced by noninvasive tests: impedance plethysmography, venous Doppler,125I‐radiofibrinogen‐uptake test, and phleborheography. Virchow's triad of stasis, vessel injury, and hypercoagulability remains a valid explanation of the pathogenesis of thrombus formation, but laboratory and clinical data have refined our knowledge of how these factors interact to result in clinically significant disease. Knowledge of the natural history of venous thrombosis, plus heightened awareness of the long‐term morbidity and expense associated with the postphlebitic syndrome, have led to increased interest in preventing DVT. Clinically and economically, venous thrombosis is best managed by preve

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04025.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

The etiology of postoperative deep venous thrombosis (DVT) is thought to be due to a combination of factors including stasis, a hypercoagulable state and venous endothelial damage. Methods of prophylaxis are directed toward correcting one or more of these pathologic events. Methods counteracting more than one of these factors can be expected to be even more effective. The combination of dihydroergotamine (DHE) and heparin was anticipated to minimize stasis and the hypercoagulable state respectively. Based upon current experimental evidence and current theory, an additional benefit might include minimizing venous endothelial injury by controlling venomotor tone. A prospective, randomized, double‐blind, multicenter trial was designed and performed in the United States evaluating the prophylactic efficacy of DHE 0.5 mg plus heparin 5000 U, DHE 0.5 mg plus heparin 2500 U, heparin 5000 U, and DHE 0.5 mg versus placebo. General surgical patients including those undergoing noncardiac thoracic and pelvic operations who were identified at moderate to high risk for postop DVT were included. Study medications were injected subcutaneously two hours preoperatively and every 12 hours postoperatively for 5–7 days or until the125I‐fibrinogen‐uptake test (RFUT) became positive. Eight hundred and eighty eight patients were entered into this trial and 744 (85%) completed the study. Results showed a statistically significant benefit from DHE/Hep 5000 compared to placebo (p<0.01) and compared to other active agents (p<0.05). None of the other active agents showed a statistically significant prophylactic benefit. This was most likely due to sample size. Intraoperative blood loss, postoperative blood loss, and the amount of blood replaced were monitored and were similar for all treatment groups and placebo. There was no significant difference in incidence of wound hematomas or injection site hematomas. The side effects were similar throughout all treatment groups and placebo. Ths US Multi‐center Trial suggests that general surgical patients who are at high risk for developing postoperative DVT can be offered safe and effective prophylaxis with the combination of DHE/hep

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04026.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

Widescale implementation of prospective payment systems as a means of reimbursing hospitals on the basis of diagnosis‐related group designation has important implications with respect to the selection of drug therapy. Instead of analyzing costs on a departmental basis, pharmacists need to identify the impact of optimal drug therapy on overall profitability. Clinically evident deep venous thrombosis and pulmonary embolism occur in approximately 3.5% and 1.8% of patients undergoing general surgery. Treatment of these complications consumes hospital resources, but the hospital absorbs the cost of treatment under the prospective payment system. Effective prophylactic measures increase profitability by preventing complications and minimizing the proportion of outliers due to increased length of stay. In selecting prophylactic measures, this impact on overall profitability is as important as acquisition cost. For example, in comparison with no prophylaxis, dihydroergotamine‐heparin reduces the frequency of deep venous thrombosis in patients undergoing general surgery by 61.5% and heparin alone reduces it by 31.2%. The relative effect of this combination on postoperative complications and resultant savings in terms of treating them compensates for differences in acquisition costs between these measu

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04027.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1986.tb04028.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY