Heparin-dihydro-ergotamine prophylaxis carries a risk of severe vascular spasm and gangrene, highlighting the need to identify high-risk groups and consider treatments like nitroprusside or nitrates.
Heparin-dihydro-ergotamine may cause limb-threatening spasm; this case report leaves open questions on incidence, risk factors, and safer alternatives.
A case is reported of a multiple trauma victim who developed severe vascular spasm whilst receiving heparin-dihydro-ergotamine thromboembolic prophylaxis which ultimately led to amputation of the right foot. Identification of high risk groups for this complication is attempted from a review of the literature. Treatment should be with intra-arterial or intravenous nitroprusside or nitrates. Little information is as yet available on the use of prostacyclin in this condition.
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Cunningham et al. (1984) studied this question.
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