Stimulation of fibrinolytic activity

Volume 3 Number 3

ACCIDENT SERVICES TODAY

of a new accident and emergency department a section set aside for the subsequent attendance of children for dresssings may be an advantage. It is, however, more important that children receive the facilities

of a full accident

specializing

in the treatment

that they are housed

team

in a unit

of trauma

in a children’s

than

ward, being a

solitary accident case amongst other conditions Requests

for

reprirm

should

be addressed

to:-A

THROMBO-EMBOLISM Postoperative Deep Venous Thrombosis Seventy-five patients over 45 and submitted to abdominal operations were used to study the comparative value of clinical examination, ultrasound, phlebography, and 126iodinated fibrinogen in the diagnosis of thrombosis. They were examined on each of 11 days, starting with the day before operation. lzSIodinated fibrinogen revealed more thrombi (33 per cent) than the other methods; 18 thrombi diagnosed in this way were also revealed by phlebography, 5 were not. Compared with scanning, clinical examination was only 50 per cent accurate and ultrasound 33 per cent accurate. In no case did scanning fail to demonstrate thrombi that were diagnosed by other means but only 2 of the 37 thrombi it revealed were shown to be above the knee. For diagnosing thrombi, iodinated fibrinogen is most reliable but for revealing the source of a pulmonary embolus phlebography ispreferable. MILNE. R. M.. GUNN. A. A.. GRIFFITHS.J. M. T.. and RU~KLEY, i:. V. (1971), ” Postoperaiive Deep Venous Thrombosis ‘, Lancet, 2,445. Stimulation of Fibrinolytic Activity Comparing two groups of 27 persons undergoing elective operations the authors found an enhancement of fibrinolytic activity in the group that received phenformin and ethyloestrenol for 6 weeks. They regarded this as justifying a clinical trial of these drugs in an attempt to reduce postoperative thromboembolism. BROWN, I. K., DOWNIE, R. J., HAGGART, B., LI~LER, J., MURRAY, G. H., ROBB, P. M., and SANTER, G. J. (1971), ‘ Pharmacological Stimulation

of Fibrinolytic

Activity

in the Surgical

where the specialized available. NAYLOR,

care for trauma

is not

REFERENCES A. (1967), ‘ The Bradford Accident Service

(1960-1965) ‘, J1.R. CON. Surg. Edinb., 12, 264. WILSON, D. H. (1963), ‘ Incidence, Aetiology, Diagnosis, and Prognosis of Closed Abdominal Injuries: a Study of 265 Consecutive Cases ‘, Br. J. Surg., 50,

381.

Naylor, Esq., Ch.M., MSc., F.R.C.S., 3 MorningtonVillas, ManninghamLane, Bradford8.

ABSTRACTS

Lancet,

157

Patient ‘,

1, 774.

Prevention of Postoperative Deep Venous Thrombosis Hydroxychloroquine reduces the tendency of platelets to stick together and form clumos from which potentially fatai thrombi can grow. ‘The drug was given to three groups of patients in 200 mg. doses, starting with prernedication for operation and thereafter every 8 hours until they left hospital. It was given by mouth or by injection. In one group no patient receiving hydroxychloroquine showed any

clinical evidence of thrombo-embolism, whereas 9 per cent of the control group showed such evidence. When thrombosis was diagnosed by phlebography between 5 and 12 days after operation, 23 per cent of the control group showed thrombosis whereas none was found in the patients receiving hydroxychloroquine. In their guarded comments the authors regarded these results as encouraging. CARTER, A. E., EBAN, R., and PERRETT, R. D. ‘ Prevention of Postoperative Deep Venous (1971), Thrombosis and Pulmonary Embolism ‘, Br. med. J., 1, 312. Heparin for Deep Vein Thrombosis The effect of small doses of heparin on the incidence of thrombosis of the deep veins of the lower limb was studied in a controlled trial on 53 persons undergoing repair of hernia over the age of 50. One of 26 (4 oer cent) of those that were eiven heoarin were shown 6y meat& of ‘?odinated f?brinogin to have developed thrombosis, in contrast to 7 of 27 (26 per cent) of those that were not given heparin. Five thousand units of calcium heparin were given by subcutaneous iniection 2 hours before and 24 hours after operation a”nd every 12 hours for the next 5 days. The success of this small dose is explained by the fact that before thrombi have begun to form the-naturally occurring inhibitor of Factor X is much more easily reinforced by heparin than when the delicate natural balance between thrombogenesis and thrombolysis has been tilted towards thrombosis. The limitations of the study are admitted, but as the authors point out, the method of trial can be widely applied. KAKKAR, V. V., FIELD, E. S., NICOLAIDES, A. N., FLUTE, P. T., WESSLER, S., and YIN, E. T. (1971),

‘ Low Doses of Heparin in Prevention Thrombosis ‘, Lancet, 2, 669.

of Deep Vein

Prevention of Pulmonary Embolism The efficacy of dextran 70 in preventing pulmonary embolism was studied in a controlled series of hiehrisk patients (fractures of pelvis, hip, and femoral shaft). There was a considerably lower incidence in the treated group. This group also showed a decrease in platelet adhesiveness and plasma fibrinogen. The higher incidence of bleeding from the surgical wound in some of the treated group is referred to as not significant. In the discussion, rkgimes based on anticoagulants are somewhat summarily dismissed. ATIK, M., HARKESS, J. W., and WICHMAN, H. (1970), ‘ Prevention of Fatal Pulmonary Embolism ‘, Surgery

Gynec. Obstet.,

130,403.