An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography

Abstract

Object. Patients requiring neurosurgical intervention are known to be at increased risk for deep vein thrombosis (DVT) and attendant morbidity and mortality. Pulmonary embolism (PE) is the most catastrophic sequela of DVT and is the direct cause of death in 16% of all in-hospital mortalities. Protocols for DVT screening and early detection, as well as treatment paradigms to prevent PE in the acute postoperative period, are needed in neurosurgery. The authors analyzed the effectiveness of weekly lower-extremity venous duplex ultrasonography (LEVDU) in patients requiring surgical intervention for cranial or spinal pathology for detection of DVT and prevention of PE.Methods. Data obtained in 1277 consecutive patients admitted to a major tertiary care center requiring neurosurgical intervention were retrospectively reviewed. All patients underwent admission (within 1 week of neurosurgical intervention) LEVDU as well as weekly LEVDU surveillance if the initial study was normal. Additional LEVDU was ordered in any patient in whom DVT was suspected on daily clinical physical examination or in patients in whom chest CT angiography confirmed a pulmonary embolus. An electronic database was created and statistical analyses performed.Results. The overall incidence of acute DVT was 2.8% (36 patients). Of these cases of DVT, a statistically significant greater number (86%) were discovered on admission (within 1-7 days after admission) screening LEVDU (p < 0.05), whereas fewer were documented 8-14 days after admission (2.8%) or after 14 days (11.2%) postadmission. Additionally, for acute DVT detection in the present population, there were no underlying statistically significant risk factors regarding baseline physical examination, age, ambulatory status, or type of surgery.The overall incidence of acute symptomatic PE was 0.3% and the mortality rate was 0%. Conclusions. Performed within 1 week of admission in patients who will undergo neurosurgical intervention, LEVDU is effective in screening for acute DVT and initiating treatment to prevent PE, thereby decreasing the overall mortality rate. Routine LEVDU beyond this time point may not be needed to detect DVT and prevent PE unless a change in the patient's physical examination status is detected. (http://thejns.org/doi/abs/10.3171/2012.11.JNS121243) key WorDs • deep vein thrombosis • ultrasonography • pulmonary embolism 505Abbreviations used in this paper: DVT = deep vein thrombosis; IVC = inferior vena cava; PE = pulmonary embolism.

Venous thromboembolism in the setting of pediatric traumatic brain injury

“…Orthopedic and neurological surgery are known to be risk factors for VTE in the pediatric 26 and adult literature. 6,16,19 Our study found TBI-associated hospitalizations involving orthopedic surgery and cranial surgery, respectively, to be 2.4 and 1.8 times more likely to be complicated by VTE. Surgery and length of hospital stay may also be useful proxy indicators for severity of injury.…”

Risks for hemorrhagic complications after placement of external ventricular drains with early chemical prophylaxis against venous thromboembolisms

“…These rates are higher than those reported for patients in a neurosurgical ICU. 14,16 In these studies, VTE screening was regimented and conducted on all patients; whereas in our study, VTE screening was performed only on patients with clinically suspected VTE. In addition, Goldstein et al 5 showed that the presence of an EVD was the only independent risk factor for a thromboembolic event among a cohort of neurological ICU patients.…”

“…18 A large retrospective review of patients in a neurological ICU determined that 86% of deep vein thromboses were detected by routine screening within the first week. 16 Early administration of chemical prophylaxis for these patients seems essential, but its use should be weighed against the potential risks for hemorrhagic complications.…”

Bleeding Risk and Thromboprophylaxis in Neurosurgical Patients after Emergency Procedure

“…In addition to VTE risk, mortality rates have also been stratified with VTE prophylaxis in mind, and institution of DVT prophylaxis results in decreased mortality risk [3][4][5]. Multiple case reports and series on postoperative thromboembolic prophylaxis have been published, however clear guidelines for a "Best Practice" have yet to be described [6][7][8].…”