Is anticoagulation for venous thromboembolism safe for Asian elective neurosurgical patients? A single centre study

The incidence of venous thromboembolism (VTE) in neurosurgical patients ranges 3-24%. VTE is potentially fatal, and prophylactic anticoagulation is recommended worldwide. However, anticoagulation poses a risk of haemorrhage, which can be devastating. We aim to determine the incidence of VTE and risk of haemorrhage following anticoagulation.

Between 1 May 2014 and 1 May 2016, all patients who underwent elective neurosurgery were recruited into our study. All patients had bilateral lower limb ultrasound to screen for deep vein thrombosis (DVT) between post-operative days 3 and 7. These patients are also monitored for manifestations of pulmonary embolism (PE). If present, a computed tomography pulmonary angiogram will be performed. Patients with VTE will either receive conservative treatment or anticoagulation.

During this period, 170 of 610 patients were included. Of the 170 patients, 17 patients (10.0%) developed DVT. Fifteen patients had cranial surgery and two patients had spinal surgery. Two patients (1.2%) developed PE and both patients had concurrent DVT. Of these 17 patients, nine patients received anticoagulation. Of these nine patients, six patients (66.7%) developed surgical site bleeding following anticoagulation and all of them required surgical intervention. Patients who were managed conservatively did not suffer haemorrhage.

Our results show an overall 10.0% incidence of DVT and 1.2% incidence of PE following elective neurosurgery within this Asian cohort of neurosurgical patients. There is also a high risk (66.7%) of significant surgical site bleeding following anticoagulation.