Risk of Deep vein thrombosis in neurosurgery: State of the art on prophylaxis protocols and best clinical practices |
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| Affiliation: | 1. Harvard Medical School, Harvard University, Boston, MA, USA;2. Nuffield Department of Clinical Neuroscience, Oxford University Hospitals, UK;3. Instituto Neurologico Besta, Milano, Italy;4. Dept of Neurosurgery, Strasbourg University Hospital, France;1. UT Southwestern Medical Center, Department of Internal Medicine, Dallas, TX, United States;2. UT Southwestern Medical Center, Department of Pathology, Dallas, TX, United States;3. Medical Sciences Institute, Blood Center of Wisconsin, Milwaukee, WI, United States;4. Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI, United States;5. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, United States;6. Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States;1. Department of Neurological Surgery, University of California, San Francisco, USA;2. Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, USA;1. Kaiser Permanente National IVC Filter Registry and Division of Vascular and Interventional Radiology, Kaiser Permanente Northern California, Santa Clara;2. Department of Internal Medicine, Kaiser Permanente Santa Clara, Santa Clara;3. Department of Radiology, Kaiser Permanente Santa Clara, Santa Clara;4. Department of Critical Care, Kaiser Permanente Santa Clara, Santa Clara;5. Department of Imaging, Kaiser Permanente Northern California Regional Imaging, Oakland, California;1. Department of Emergency Medicine, San Antonio Military Medical Center, 3841 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA;2. Department of Emergency Medicine, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA |
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| Abstract: | ![]()
ObjectiveTo analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world.Data sourcesAnalysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978).Data extraction80 abstracts were reviewed, and 74 articles were extracted.Data analysisThe majority of DVT seems to develop within the first week after a neurosurgical procedure, and a linear correlation between the duration of surgery and DVT occurrence has been highlighted. The incidence of DVT seems greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression (IPC) devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) further reduced the incidence, not always of DVT, but of PE. Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative haemorrhages: 2–4% in cranial series, 3.4% minor and 3.4% major haemorrhages in combined cranial/spinal series, and a 0.7% incidence of major/minor haemorrhages in spinal series.ConclusionThis analysis showed that currently most of the articles are represented by case series and case reports. As long as clear guidelines will not be defined and universally applied to this diverse group of patients, any prophylaxis for DVT and PE should be tailored to the individual patient with cautious assessment of benefits versus risks. |
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| Keywords: | Deep vein thrombosis Pulmonary embolism Intermittent pneumatic compression devices Low molecular-weight heparin (LMWH) Neurosurgery |
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