Thromboprophylaxis in neurosurgical patients

Neurosurgical patients constitute one of the highest risk groups for postoperative thromboembolic complications. Physical methods of thromboprophylaxis have been successful in reducing the incidence of postoperative deep vein thrombosis (DVT) but the residual incidence remains considerable. Many neurosurgeons are reluctant to use perioperative anticoagulant prophylaxis, despite its proven success in reducing DVT rates, because of the potentially serious consequences of even a small intracranial bleed. Recent studies have indicated that a combination of graduated compression stockings (GCS) and low-molecular-weight heparin (LMWH), started in the postoperative period, significantly reduces the incidence of DVT compared with GCS alone. Postoperative regimens avoid the risk of surgical hemorrhage and appear to offer increased protection for this group of patients.