Our Experiences with Prophylaxis of Postoperative Thromboembolic Complications

Prophylaxis of thromboembolism in the neurosurgical patient remains a difficult problem as anticoagulant treatment increases the inherent risk of hemorrhage into the operative site. Neurosurgical patients constitute one of the highest risk groups for postoperative thromboembolic complications. Physical methods of thromboprophylaxis have been successful in reducing the incidence of postoperative deep vein thrombosis (DVT), but the residual incidence remains considerable. Postoperative regimens avoid the risk of surgical hemorrhage and appear to offer increased protection for this group of patients.

We begin with systematic thromboembolic prophylaxis in 1997. During this time we had in series 11,663 patients with craniocerebral surgery and from these, 3,888 patients with skull base procedures.

Our method of prophylaxis is combine mechanical compression stockings and low-molecular-weight heparin (LMWH) and water internal body management of patients.

For prophylaxis in craniocerebral procedures, we have two groups: elective and urgent.

In elective group, we started with prophylactic therapy of LMWH early (6–10 hours after surgery procedure), with postoperative control CT, which we take 4 to 8 hours after surgery, without hemorrhagic complication. Mechanical compression stockings begin before surgery procedures and keeping it minimally 4 to 5 days after surgery, when patient normally starts walking.

In urgent group and group with hemorrhagic complication, we begin with prophylactic treatment later, after 72 hours. Mechanical compression stockings begin before surgery procedures and keeping as long as needed.

Our results of pulmonal embolism (PE): from a total of eight patients (0.06%) only one death (0.008%) occurred. In skull base group 2 cases (0.05%). The hemorrhagic complications occurred during prophylaxis in four patients (0.03%) and one death (0.008%) due to massive PE and hemorrhagic complication during therapy.

In our group in very important evolution of fibrinogen level. This problem author discussed. From viewing on problem of treatment there is important dualistic process: thrombotic and thrombolytic in one time.

The author discussed to problems from literature.

Many neurosurgeons are reluctant to use perioperative anticoagulant prophylaxis, despite its proven success in reducing DVT rates, because of the potentially serious consequences of even a small intracranial bleed. Recent studies have indicated that a combination of graduated compression stockings (GCS) and low-molecular-weight heparin (LMWH), started in the postoperative period, significantly reduces the incidence of DVT compared with GCS alone.