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BACKGROUND: The incidence of venous thromboembolism (VT) in neurosurgical practice is astonishingly high, representing a major cause of morbidity and mortality. Prophylaxis strategies include elastic stockings, low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) devices. OBJECTIVE: To assess the safety and efficacy of 2 different VT prophylaxis protocols implemented in a European neurosurgical center. METHODS: All patients admitted for neurosurgical intervention between 2012 and 2016 were stratified as low, moderate, and high risk of VT and received a combination of elastic stockings and LMWH. The protocol was modified in 2014 with the inclusion of perioperative IPC devices for all patients and only in the high-risk group also postoperatively. RESULTS: At time of post-hoc analysis, data obtained from patients included in this study before 2014 (Protocol A, 3169 patients) were compared with those obtained after the introduction of IPC (Protocol B, 3818 patients). Among patients assigned to protocol A, 73 (2.3%) developed deep-vein thrombosis (DVT) and 28 (0.9%) developed pulmonary embolism (PE), 9 of which were fatal (0.3%). Among patients assigned to protocol B, 32 developed DVT (0.8%) and 7 (0.18%) developed PE, with 2 eventually resulting in the death of the patient. A post-hoc analysis confirmed that the use of preoperative LMWH was not associated with a statistically significant greater risk of postoperative bleeding. CONCLUSIONS: This study, despite its limitations of the nonrandomized design, seems to suggest that perioperative IPC devices are a non-negligible support in the prophylaxis of clinically symptomatic DVT and PE.

Original publication

DOI

10.1016/j.wneu.2017.10.012

Type

Journal article

Journal

World Neurosurg

Publication Date

01/2018

Volume

109

Pages

e510 - e516

Keywords

Deep venous thrombosis (DVT), Intermittent pneumatic compression (IPC) devices, Low-molecular-weight heparin (LMWH), Neurosurgery, Pulmonary embolism (PE), Aged, Anticoagulants, Clinical Protocols, Female, France, Heparin, Low-Molecular-Weight, Humans, Intermittent Pneumatic Compression Devices, Intracranial Hemorrhages, Male, Middle Aged, Neurosurgical Procedures, Postoperative Complications, Prospective Studies, Pulmonary Embolism, Risk Assessment, Stockings, Compression, Venous Thromboembolism, Venous Thrombosis