Venous Thromboembolism Prophylaxis after Head and Spinal Trauma: Intermittent Pneumatic Compression Devices Versus Low Molecular Weight Heparin

Abstract

Although there are alternative methods and drugs for preventing venous thromboembolism (VTE), it is not clear which modality is most suitable and efficacious for patients with severe (stable or unstable) head/spinal injures. The aim of this study was to compare intermittent pneumatic compression devices (IPC) with low-molecular-weight heparin (LMWH) for preventing VTE. We prospectively randomized 120 head/spinal traumatized patients for comparison of IPC with LMWH as a prophylaxis modality against VTE. Venous duplex color-flow Doppler sonography of the lower extremities was performed each week of hospitalization and 1 week after discharge. When there was a suspicion of pulmonary embolism (PE), patients were evaluated with spiral computed tomography. Patients were analyzed for demographic features, injury severity scores, associated injuries, type of head/spinal trauma, complications, transfusion, and incidence of deep venous thrombosis (DVT) and PE. Two patients (3.33%) from the IPC group and 4 patients (6.66%) from the LMWH group died, with their deaths due to PE. Nine other patients also succumbed, unrelated to PE. DVT developed in 4 patients (6.66%) in the IPC group and in 3 patients (5%) in the LMWH group. There was no statistically significant difference regarding a reduction in DVT, PE, or mortality between groups ( p = 0.04, p > 0.05, p > 0.05, respectively). IPC can be used safely for prophylaxis of VTE in head/spinal trauma patients.

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

“…In a randomized trial of neurosurgery patients, Turpie et al corroborated this data by reporting the incidence of DVT at 8.8% in patients using high-pressure stockings, 9% in patients using IPC, and 19.8% in an untreated control group [81]. Kurtoglu et al similarly reported that IPC was as effective as low molecular weight heparin in DVT prophylaxis following head and spinal trauma [32]. Often, IPC and compression stockings are combined for use in a single patient.…”

“…Several studies have compared the effectiveness of chemical anticoagulation with the effectiveness of mechanical prophylaxis [7,32,36,45,52,74,82]. Many of these studies show that combined prophylaxis has a higher effectiveness in preventing VTE without increasing risk to the patient than either method alone ( …”

“…VTE filters are placed most frequently in the inferior vena cava (IVC) to prevent a circulating clot from becoming a PE. IVC filters have been shown to be extremely effective in preventing the development of PE and in decreasing the morbidity and mortality of patients known to be harboring VTE of any kind [10,11,32,34].…”

“…Several studies have shown that the rates of post-operative hemorrhage are higher in patients undergoing resection of a brain tumor than those in patients undergoing trauma or spinal neurosurgery [32,52,76,77]. Carman et al surveyed American neurosurgeons and reported that, generally, they underestimate the risk of DVT after brain surgery, and tend to avoid the use of chemoprophylaxis [84].…”

“…Patients harboring brain tumors are more likely to develop VTE than patients who have cancers in other sites (Table 1) . Studies have shown that other risk factors for VTE include age, sex, ethnicity, blood type, length of hospital stay, operative duration, and coagulation status [3,6,[8][9][10]14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Standard prophylactic measures for VTE include chemical anticoagulation, mechanical prophylaxis, and increased ambulation during the post-operative period [36,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54].…”