Venous thromboembolism in neurologic disease

Patients with neurologic disease are at high risk of venous thromboembolism (VTE) because of relative immobility. They are also at increased risk due to the presence of a hypercoagulable state. Patients with spinal cord injuries, brain tumors, and strokes are at particularly high risk and extra vigilance is needed in these patients. Because VTE is very common in hospitalized neurologic and neurosurgical patients, mechanical thromboprophylaxis is indicated in virtually all patients. Pharmacologic prophylaxis with either subcutaneous heparin or low molecular heparinoids should be given to all high-risk neurologic and neurosurgical patients provided there are no major contraindications. The major concern would be a risk of bleeding but in some patients alternate drugs must be considered given the risk of thrombosis (i.e., in the context of heparin-induced thrombocytopenia). The immediate or long-term treatment of full dose anticoagulation for VTE may not be appropriate in all patients as VTE therapy represents a balance between the risks of bleeding related to anticoagulant therapy versus the risk of recurrent events. An inferior vena cava (IVC) filter is another option in these patients but may not necessarily be the best choice for most neurologic patients. Given the high risk of VTE in patients with neurologic diseases, early recognition by clinicians of the signs and symptoms of VTE is essential.