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February 1, 1985

Dihydroergotamine-Heparin Prophylaxis of Postoperative Deep Vein Thrombosis-Reply

JAMA. 1985;253(5):637. doi:10.1001/jama.1985.03350290038024

In Reply.—  Dr Sautter's interesting and perceptive letter concerning the location of thrombi and the appropriateness of using the radiofibrinogen leg scan as the diagnostic end point were indeed given serious consideration by the investigators.We agree as stated in our article that proximal vein thrombosis poses a greater risk for pulmonary embolism developing. The incidences of proximal vein thrombosis in our trial are given in the Table.Although there appears to be a benefit with the combination of dihydroergotamine and heparin (5,000 IU), we pointed out in our article that there was inadequate power to permit analysis for statistical differences.We also agree with Dr Sautter that the radiofibrinogen leg scan lacks adequate sensitivity for detecting upper thigh and pelvic thrombi. However, again, as stated in our article, this is not a serious disadvantage in general surgical patients. Thrombi infrequently originate in this region,1,2 except in patients undergoing