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Dihydroergotamine-Heparin Prophylaxis of Postoperative Deep Vein Thrombosis

Richard D. Sautter, MD
JAMA. 1985;253(5):637. doi:10.1001/jama.1985.03350290038023.
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To the Editor.—  I read with great interest in the June 8 issue of JAMA the article entitled "Dihydroergotamine-Heparin Prophylaxis of Postoperative Deep Vein Thrombosis."1 I was flattered to have my article entitled "The Limited Utility of Fibrinogen I-125 Leg Scanning" referenced by this group.I am well aware of the problems of multicenter trials and have great admiration for a group that enrolled 880 patients. However, I believe there are serious flaws in the methodology of this trial. I am concerned that the anatomic location of the thrombi were not identified. It is one thing to prevent thrombi in the lower extremity and quite another to prevent thrombi above Hunter's canal (located on the medial aspect of the middle third of the thigh), where the propensity for embolization is much greater, resulting in life-threatening pulmonary embolization. There seems to be a difference of opinion among the experts on

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