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February 1, 1985

Dihydroergotamine-Heparin Prophylaxis of Postoperative Deep Vein Thrombosis

Author Affiliations

Savannah. Ga

JAMA. 1985;253(5):636-637. doi:10.1001/jama.1985.03350290038021

To the Editor.—  The question not asked in the multicenter trial study1 is, who does not need dihydroergotamine and heparin prophylaxis against DVT during major surgery? Nor is the question raised by Jack Hirsh2 in his editorial in the same issue.The study, of course, asked the question, "Does this prophylaxis work?" The answer was in the affirmative. Yet, my question is not unimportant.Many will conclude from this study that all patients older than 40 years undergoing major surgery, barring a contraindication, should have this prophylaxis. They would fall into the category of followers of the American Hippocrates, Dr Benjamin Rush, who did not believe in vis medicatrix naturae but that the wise physician always interceded and left nothing to nature or to chance.3 Others might consider that of the overall 880 patients studied, subtracting all of those in whom DVT developed in the placebo and