[Prevention of deep venous thrombosis (TVP) and pulmonary embolism. Comparison of heparin (3 x 5000 IU/day), heparin (2 x 5000 IU/day) + 0.5 mg dihydroergot, and physiotherapy (intermittent compression stockings + physical exercise). Value of Doppler diagnosis in systematic detection of TVP compared with phlebography and scanning of the legs using labelled fibrinogen].
We compared the protective value of the above treatments in 227 randomised patients. Investigations in each patient included pulmonary scanning before and after operation, repeated postoperative Doppler and radioactive limb scanning completed by phlebography to confirm positive results. The heparin DHE group and the "physiotherapic" group each totalized 76 patients and the heparin group 75. These comparable groups show that HDHE and heparin prophylaxis are identical; but physiotherapy is perhaps better. Compared with phlebography leg scanning sensitivity is 95%, whilst it's specificity is 99%. Doppler sensitivity is only of 21%, whilst it's specificity is 95%. In conclusion, "physiotherapic" prophylaxis, including Flowtron, is as effective as heparin alone. Doses of heparin may be reduced, without loss of effect, if supplemented by a veinoconstrictive agent as DHE. The low Doppler sensitivity contraindicates its use in asymptomatic DVT detection.
D000328:Adult; D000368:Aged; D003020:Clothing; D004087:Dihydroergotamine / Q000627:therapeutic use; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005081:Exercise Therapy; D005260:Female; D005340:Fibrinogen / Q000032:analysis; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D007866:Leg / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D026741:Physical Therapy Modalities; D011183:Postoperative Complications / Q000517:prevention & control; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000517:prevention & control*; D011877:Radionuclide Imaging; D011897:Random Allocation; D013924:Thrombophlebitis / Q000175:diagnosis / Q000517:prevention & control*; D014463:Ultrasonography
D004087:Dihydroergotamine; D005340:Fibrinogen; D006493:Heparin
Prévention des thromboses veineuses profondes (TVP) et des embolies pulmonaires. Comparaison de l'héparine 3 x 5000 UI/jour, de l'héparine 2 x 5000 UI/jour + 0,5 mg dihydergot et de la physiothérapie (bottes à compression intermittente + exercices physiques) - valeur du Doppler dans la détection systématique des TVP comparé à la phlébographie et au scanning des jambes au fibrinogène marqué.