Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis

Abstract

Based on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.

Severe Leg Pain Following Spinal Cord Stimulator Implantation – A Case Report

“…They found this aggressive protocol for early VTE prophylaxis after spine surgery decreased VTE incidence without increasing morbidity . A recent meta‐analysis drew a similar conclusion . However, the catastrophic morbidity of a symptomatic postoperative epidural hematoma remains a substantial disincentive for surgeons to initiate chemoprophylaxis after spinal surgery.…”

Deep Venous Thrombosis Chemoprophylaxis in Lateral Skull Base Surgery for Vestibular Schwannoma

“…Khan et al found a significant reduction in DVT with LMWH/UR (OR 0.51, 95% CI, 0.37–0.71; P < .0001.) . They did not find any significant increase in major intracranial hemorrhage ( P = .60), major extracranial hemorrhage ( P = .98), or minor bleeding complications ( P = .60) .…”

“…They did not find any significant increase in major intracranial hemorrhage ( P = .60), major extracranial hemorrhage ( P = .98), or minor bleeding complications ( P = .60) . Additionally, in most of these studies, LMWH/UH was started preoperatively and continued post‐operatively while hospitalized . This is the strongest evidence to date arguing for chemoprophylaxis in the neurosurgical population.…”

“…More recently, Khan et al recently performed a systematic review and meta‐analysis with nine relatively homogenous randomized controlled trials of neurosurgical patients (craniotomy and spine patients) comparing either LMWH/UH to placebo or LMWH/UH with CS to CS alone with 1232 patients . Of note, the majority of patients included in this systematic review underwent craniotomy as opposed to spinal surgery . Khan et al found a significant reduction in DVT with LMWH/UR (OR 0.51, 95% CI, 0.37–0.71; P < .0001.)…”

Thromboprophylaxis in Neuro Intensive Care Unit

“…There have been various systematic reviews in the last two decades on the topic of efficacy of thromboprophylaxis to include pharmacological methods in addition to the widely prevalent mechanical modalities. 6 Various subsets of neurological injury are relevant in present day neurocritical care (►Table 1).…”