In Reply: Commentary: What We Might or Might Not Know About Venous Thromboembolism Prophylaxis in Neurosurgery

Abstract

The purpose of my commentary 2 was to point out that the existing data are inadequate to support firm recommendations for elective postcraniotomy thromboembolism prophylaxis. That understanding provides support for individual surgeons and institutions to incorporate the data that do exist into the complex judgment about what to do for individual patients in their local practice and institutional settings with the understanding that such judgments may vary from place to place, person to person, and time to time.That variation in practice, which we would ideally like to decrease, is the result of insufficient data of high quality. The authors of the letter have clearly outlined the reasons for this lack of data and the efforts that would be required to rectify that deficiency. The incidence of postcraniotomy thromboembolism in the elective scenario is relatively low, but the consequences can be severe. The complications of prophylaxis can also be serious. As the risk of other serious complications declines, the thromboembolic risks become relatively more important. At some point in time, they will become important enough that there will be support for the kind of major collaborative effort the authors describe.I applaud the work they have already done and the work they hope that the neurosurgical and neurocritical care communities will do together in the future to improve the clinical science upon which our efforts to minimize postcraniotomy thromboembolism are based.