The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis

Henwood, Patricia C.; Kennedy, Tom; Thomson, Lynda; Galanis, Taki; Tzanis, George; Merli, Geno J.; Kraft, Walter K.

doi:10.1007/s11239-011-0583-8

Cited by 31 publications

(16 citation statements)

References 22 publications

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“…The discrepancy in reported rates of DVT is likely multifactorial. First, increased awareness of DVT complications may be leading to increased use of pharmacological prophylaxis and combination mechanical-pharmacological prophylaxis, 5 which in turn may be decreasing the overall number of DVTs. The majority of patients in this study did not receive chemoprophylaxis, a practice which is becoming increasingly less common in the neurointensive care unit setting.…”

Section: Discussionmentioning

confidence: 99%

“…13 DVT is a common complication of aneurysmal subarachnoid hemorrhage (aSAH) associated with increased death and disability. 1,3,5,11,14–16 Two recent retrospective studies used screening ultrasound to estimate the incidence of DVT in aSAH to be 24% 14 and 9.7%. 15 A large retrospective review of nearly 16,000 patients from the Nationwide Inpatient Sample database found that the incidence of DVT was 3.5% and the incidence of DVT and pulmonary embolism was 4.4%.…”

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confidence: 99%

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Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

Su¹,

Liu

Doğan

et al. 2015

JNS

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OBJECT Deep vein thrombosis (DVT) is a common complication of aneurysmal subarachnoid hemorrhage (aSAH). The time period of greatest risk for developing DVT after aSAH is not currently known. aSAH induces a prothrombotic state, which may contribute to DVT formation. Using repeated ultrasound screening, the hypothesis that patients would be at greatest risk for developing DVT in the subacute post-rupture period was tested. METHODS One hundred ninety-eight patients with aSAH admitted to the Oregon Health & Science University Neurosciences Intensive Care Unit between April 2008 and March 2012 were included in a retrospective analysis. Ultrasound screening was performed every 5.2 ± 3.3 days between admission and discharge. The chi-square test was used to compare DVT incidence during different time periods of interest. Patient baseline characteristics as well as stroke severity and hospital complications were evaluated in univariate and multivariate analyses. RESULTS Forty-two (21%) of 198 patients were diagnosed with DVT, and 3 (2%) of 198 patients were symptomatic. Twenty-nine (69%) of the 42 cases of DVT were first detected between Days 3 and 14, compared with 3 cases (7%) detected between Days 0 and 3 and 10 cases (24%) detected after Day 14 (p < 0.05). The postrupture 5-day window of highest risk for DVT development was between Days 5 and 9 (40%, p < 0.05). In the multivariate analysis, length of hospital stay and use of mechanical prophylaxis alone were significantly associated with DVT formation. CONCLUSIONS DVT formation most commonly occurs in the first 2 weeks following aSAH, with detection in this cohort peaking between Days 5 and 9. Chemoprophylaxis is associated with a significantly lower incidence of DVT.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

Su¹,

Liu

Doğan

et al. 2015

JNS

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“…A recent study, which followed a biweekly ultrasonography screening protocol, revealed an overall DVT incidence of 9.7%, which was compiled from 237 cranial and spinal patients. 19 This particular study's protocol was to administer chemical prophylaxis with unfractionated heparin 5000 U twice daily and mechanical prophylaxis with pneumatic compression sleeves within 24 hours of admission.…”

Section: Discussionmentioning

confidence: 99%

“…2,15,23 While this modality is not as sensitive for diagnosing DVT as the gold standard of lower-extremity venography, 14 it has certainly helped in earlier and increased detection of DVTs. 8,11,19 What remains unclear is when and how often these ultrasound studies should be performed to maximize DVT screening and detection, as well as possibly improve In the present study, over a period of 1 year, we investigated, in an acute inpatient setting, the usefulness of routine screening ultrasonography in all neurosurgical patients and determined whether there are any differences between the various subsets of the population. To ascertain if there is an optimal time window for DVT screening, we also analyzed the frequency and duration of ultrasound surveillance.…”

mentioning

confidence: 99%

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

Patel¹,

Koltz²,

Sansur³

et al. 2013

JNS

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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.

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“…In patients with head injury or stroke, DVT may be asymptomatic, and VDU has been proposed as a screening tool even though current guidelines do not recommend this approach (Rogers et al, 2002;Geerts et al, 2008;Henwood et al, 2011;Khaldi et al, 2011;Raslan et al, 2010). In patients with head injury or stroke, DVT may be asymptomatic, and VDU has been proposed as a screening tool even though current guidelines do not recommend this approach (Rogers et al, 2002;Geerts et al, 2008;Henwood et al, 2011;Khaldi et al, 2011;Raslan et al, 2010).…”

Section: Venous Thromboembolism Screening In Neurologic and Neurosurgmentioning

confidence: 99%

Venous thromboembolism in neurologic disease

Schneck

2014

Handbook of Clinical Neurology

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The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis

Cited by 31 publications

References 22 publications

Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

Timing of deep vein thrombosis formation after aneurysmal subarachnoid hemorrhage

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

Venous thromboembolism in neurologic disease

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