Deep Venous Thrombosis and Pulmonary Embolism in Neurosurgery: A Review of the Risks and Benefits of Prophylaxis

Abstract

Background : In neurosurgery and spine surgery in particular, the unique risks and benefits of utilizing different prophylaxis regimens against deep venous thrombosis (DVT) and pulmonary embolism (PE) must be carefully weighed. Our aim was to comprehensively review the safety and efficacy of different regimens of prophylaxis against DVT and PE in neurosurgical cranial and spinal studies.
Methods : Patients undergoing cranial or spinal procedures may receive one or more types of prophylaxis; elastic stockings (ES), intermittent pneumatic compression stockings (IPC), low dose unfractionated subcutaneous heparin (typically 5000 U q12h), and/or low dose low molecular weight heparin alternatives. The incidence of DVT, PE, and hemorrhage, particularly for those receiving low dose fractionated or low molecular weight heparin, were reviewed.
Results : IPC stockings appeared to be very effective, particularly in spinal surgical series where the frequency of DVT/PE remained lower than in cranial studies. Although the addition of low dose unfractionated subcutaneous or low dose low molecular weight heparin regimens further decreased the frequency of DVT and PE, it carried a 2%-4% risk of major postoperative hemorrhage.
Conclusions : Intermittent compression stocking prophylaxis (IPC) alone provide adequate prophylaxis against DVT and PE in most patients undergoing spinal procedures. The “value added” of low dose unfractionated subcutaneous or low dose low molecular weight heparin regimens regarding further reduction in the incidence of DVT and PE, poses the significant risk of major postoperative hemorrhage.