title: Reversible vasospasm in association with the use of heparin and dihydroergotamine.
abstract: A case of reversible vasospasm is reported in a 54-year-old man with a closed bimalleolar ankle fracture. On admission the patient had normal distal pulses and laboratory studies. He was a heavy smoker who continued to smoke in the hospital. Deep venous thrombosis (DVT) prophylaxis included dihydroergotamine and heparin (DHE-H). In the early postoperative period, marked spasm of all three arteries developed on the operative side. Smoking privileges and DHE-H were discontinued. The vasospasm resolved after intraarterial nitroglycerin. This case suggests an infrequent but potentially limb-threatening complication of DHE-H.
authors.affiliation: Department of Orthopaedic Surgery, Mt. Sinai Medical Center, Cleveland, Ohio.
authors.forename: E J
authors.initials: EJ
authors.lastname: Bachner
authors.forename: R M
authors.initials: RM
authors.lastname: Konsens
authors.forename: L
authors.initials: L
authors.lastname: Priem
authors.forename: T
authors.initials: T
authors.lastname: King
authors.forename: A I
authors.initials: AI
authors.lastname: Froimson
mesh_terms: D016512:Ankle Injuries / Q000601:surgery; D000075202:Contraindications; D004087:Dihydroergotamine / Q000009:adverse effects* / Q000627:therapeutic use; D004338:Drug Combinations; D005528:Foot / Q000098:blood supply*; D005593:Fracture Fixation, Internal; D050723:Fractures, Bone / Q000601:surgery; D006493:Heparin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007511:Ischemia / Q000139:chemically induced*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013924:Thrombophlebitis / Q000517:prevention & control
chemical_list: D004338:Drug Combinations; D004087:Dihydroergotamine; D006493:Heparin