Thromboprophylaxis in neurosurgical patients at Jordan university hospital: a prospective comparative study

ABSTRACT

Venous Thromboembolism [VTE] is potentially a life threatening complication in patients undergoing major neurosurgical procedures. There has been a general reluctance over the years to use anticoagulant prophylaxis for patients with head injury or in patients who need intracranial surgery. Intermittent Pneumatic Compression [IPC] and elastic stocking are widely used as prophylaxis against venous thrombo-embolism in these patients. The aim of the study is to assess and compare the value of VTE prophylaxis using a control group with Low dose Unfractionated Heparin [LDUH] every eight hours alone with a study group using Intermittent Pneumatic compression [IPC] and elastic stocking along with Single dose Unfractionated Heparin [SDUH] at the time of anaesthesia in induction on patients undergoing brain and spinal surgery. A prospective case-control study was conducted at Jordan University Hospital, over 15 months during the period 2005-2006. A total of 223 patients were included. In the study group, 113 patients using single dose of unfractionated heparin at the time of anaesthesia induction along with Intermittent Pneumatic Compression [IPC] intraoperatively and compression Elastic Stocking [ES] post operatively were used until full ambulation. In the control group, there were 110 patients in whom unfractionated heparin at a dose of 5000 units every 8 hours was used until full ambulation or for 7 days. All patients underwent either brain surgery or spinal surgery. The characteristics of the two groups were fully comparable except for the duration of surgery which was statistically longer in the study group [P= <0.001]. Deep Vein Thrombosis [DVT] occurred in 3 patients in the study group, compared to 6 patients in the control group, of these 6 patients, 4 patients developed PE in addition to DVT and one of the four patients expired. The observed differences among these rates are statistically not significant [P=0.288]. When pooled together, patients who developed VTE in both groups were older than those who did not have VTE. This difference was statistically significant [P=0.07]. The combination of elastic stocking, intermittent pneumatic compression along with single dose unfractionated heparin at the time of anaesthesia induction is comparable in effectiveness of reducing the incidence of VTE as the low dose unfractionated heparin alone in patients undergoing neurosurgical procedures of the brain or spine, despite the trend towards better results of the combined method: