Deep Vein Thrombosis and the Neurosurgical Patient

Abstract

BackgroundNeurosurgical patients are varied, encompassing cranial and spinal diseases and trauma, and are admitted under both elective and emergency settings. In all settings, neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT). We conducted a study to identify the factors associated with DVT among neurosurgical patients, and the overall rate of occurrence at our centre. We aimed to also compare our results to the incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis was undertaken. We also included the Well’s score to validate its usefulness in screening for DVT in our local setting.MethodsAll patients admitted into our centre were screened for eligibility and those who underwent surgery from September 2016 to September 2017 had a D-dimer screening after surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant therapy was not influenced by this study, and observation of the use was in keeping with usual practices in our centre was done.ResultsA total number of 331 patients were recruited in this study, however, after the inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate analysis, the Well’s score and the number of days in bed remained statistically significant, after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT prophylaxis with an adjusted odd’s ratio, and a confidence interval of 95%, and P < 0.05 for each.ConclusionWell’s scoring and number of days in bed were independent factors affecting the rate of DVT in patients undergoing neurosurgical procedures in our centre.

Prognostic Nomogram for Predicting Lower Extremity Deep Venous Thrombosis in Neurointensive Care Unit Patients: A Prospective Observational Study

“…In addition, the D-dimer level has been previously confirmed as a sensitive indicator to predict the occurrence of venous thromboembolism in patients (2,18,19). Our results further supported that the D-dimer level has a reference value for the early judgment of lower extremity DVT (OR = 1.040, 95% CI: 1.008-1.074).…”

“…Therefore, it will be more meaningful to explore the optimal prophylaxis and treatment protocols for DVT in combination with the above risk factors in the setting of the COVID-19 pandemic. Additionally, several risk factors reported by previous studies were not involved in this study, such as malignant tumor (1,2), application of dehydration drugs (2), and femoral CVC (in this study, we did not distinguish the superior vena cava catheter from the femoral CVC, which may have led to the femoral CVC being identified as a non-significant variable) (13,25). Lastly, although we found that age and D-dimer level were independent risk factors for DVT, we did not further explore the age and D-dimer thresholds that could indicate lower extremity DVT in neurointensive care unit patients.…”

“…Patients admitted to the neurointensive care unit are at a high risk for lower extremity deep vein thrombosis (DVT) due to factors such as disturbance of consciousness, craniotomy, paralysis, and maintaining a long-term bedridden state (1)(2)(3)(4). Studies have shown that the incidence can be as high as 43-50% (5,6).…”

Perioperative Deep Vein Thrombosis and D-dimer Measurement in Patients with Brain Tumor

“…A previous study has demonstrated that the VTE risk factors in patients following craniotomy are aging, BMI, tumor history, operative time, chronic steroid use, presence of motor deficit, Wells score, etc. 2 , 5 , 7 , 11 , 12 ) As a limitation of our study, the D-dimer plasma levels were not measured at exactly the same time for each patient before and after surgery. Moreover, the small number of cases affected the statistical outcomes, which resulted in a lack of significance in cases of operation and anesthesia time, steroid use, and postoperative motor deficit.…”

Incidence and Risk Factors for Superficial and Deep Vein Thrombosis in Post-Craniotomy/Craniectomy Neurosurgical Patients

“…Venous thromboembolism (VTE), which includes deep vein thrombosis (DVT), superficial vein thrombosis (SVT), and pulmonary embolism (PE), can be life-threatening and affects approximately 10 million Americans annually [1]. DVT occurs when a blood clot forms in the deep veins of the pelvis or legs or less frequently in the arms [2]. Peripheral venous thrombosis is among the most common post-operative complications in neurosurgical patients [3].…”