Clinical Guidelines for the Prevention of Venous Thromboembolism in Neurosurgery

The prevalence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in patients undergoing neurosurgery is reported to be up to 25%. Mortality from this complication has been reported between 9% and 50% due to PE. Even with the use of pneumatic pressure devices, the prevalence of DVT is reported to be up to about 32% in these patients, so prophylactic treatment with heparin is of particular importance. Application of low molecular weight heparin (LMWH) reduces the prevalence of DVT by 40-50% in neurosurgery patients. Our neurosurgeon must strike a balance between the risk of venous thromboembolism (VTE) and the increased risk of bleeding from heparin prophylaxis for DVT and pulmonary embolism. The aim of this study was to provide clinical recommendation for prevention of VTE in neurosurgical cases.

Here we try to review the available scientific sources on the prevalence and risk factors for VTE in neurosurgery patients and up-to-date recommendations and guidelines for mechanical (Intermittent pneumatic compresion and anti-embolic stocking) and pharmacological  (low-dose unfractionated heparin or LMWH) prophylaxis of VTE in patients with neurosurgery.

Strength of panel opinion (including 6 neurosurgeons) assessed by the weights of each risk factor for thromboembolism during and after cranial and spinal surgery was calculated. The risk factors with less than 50% of the panel opinion were excluded. At last the results were inserted within evaluation forms for each risk factor. Measuring level of agreement (kappa coefficient) between 6 persons of expert panel for evaluating risk factors during and after cranial and spine surgery was calculated.

In all neurosurgery patients, mechanical prophylaxis should begin at the time of admission and continue for up to 30 days if immobilized, or until the person is mobilized. Drug prophylaxis also increases the effectiveness of mechanical prevention and should be considered in patients at high risk for VTE.