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10:26
A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis
Published on: June 2, 2015
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Thromboembolic prophylaxis in neurosurgical practice: a systematic review
Zhaoyuan Zhang1, Husule Cai2, Carmen L A Vleggeert-Lankamp2,3
1Department of Neurosurgery, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands. z.zhang@lumc.nl.
Acta Neurochirurgica
|October 5, 2023
Summary
Neurosurgical patients face high venous thromboembolism (VTE) risks. While several prophylaxis methods reduce VTE, data variability prevents establishing an optimal strategy, recommending systematic screening for deep vein thrombosis (DVT).
Area of Science:
- Neurosurgery
- Vascular Surgery
- Critical Care Medicine
Background:
- Neurosurgical patients have a high risk of venous thromboembolism (VTE) due to prolonged surgery, immobilization, and potential neurological deficits impacting mobility.
- There is a lack of consensus in neurosurgical practice regarding the optimal prophylaxis strategy (mechanical vs. pharmacological) for VTE.
Approach:
- A systematic literature review was conducted across major databases (PubMed, Embase, Web of Science, Cochrane Library, EmCare).
- Studies were selected based on predefined criteria, and risk of bias was assessed using established tools (Newcastle-Ottawa Scale, Cochrane risk of bias).
Key Points:
- Twenty-five studies were included, with VTE incidence significantly higher when assessed by systematic screening (e.g., duplex ultrasound) compared to clinical evaluation.
- Incidence of deep vein thrombosis (DVT) without prophylaxis ranged from 4-10%, while various prophylaxis methods (LMWH, CS, IPC) showed variable reductions.
- Pulmonary embolism (PE) incidence ranged from 0-7.9%.
Conclusions:
- Low molecular weight heparin, compression stockings, and intermittent pneumatic compression devices demonstrated VTE reduction, but data variability precludes defining an optimal strategy.
- Systematic screening for DVT is recommended in neurosurgical patients at high risk to prevent PE.
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