Deep venous thrombosis and pulmonary embolism in neurologic and neurosurgical disease

Patients with neurologic disease are at high risk of venous thromboembolism (VTE) (deep venous thrombosis [DVT] or pulmonary embolism [PE]) because of relative immobility or an increased risk of hypercoagulable states. Patients with spinal cord injuries, brain tumors, and strokes are at particularly high risk for VTE. Well-established risk assessment tools and a number of well-defined diagnostic tests to establish a VTE diagnosis are available. Unfortunately, physicians, in both the inpatient and outpatient settings, often do not have a sufficiently high level of clinical suspicion for DVT or PE, and the diagnosis is sometimes missed. The treatment of VTE is anticoagulation unless the patient is at unacceptably high risk for serious bleeding complications. The duration of anticoagulation depends on the presence of underlying hypercoagulable states and a prior history of VTE.