Journal of Thrombosis and Thrombolysis

, Volume 32, Issue 2, pp 209-214

First online:

The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis

  • Patricia C. HenwoodAffiliated withDepartment of Emergency Medicine, Brigham and Women’s Hospital Email author 
  • , Thomas M. KennedyAffiliated withJefferson Vascular Center, Thomas Jefferson University
  • , Lynda ThomsonAffiliated withJefferson Vascular Center, Thomas Jefferson University
  • , Taki GalanisAffiliated withJefferson Vascular Center, Thomas Jefferson University
  • , George L. TzanisAffiliated withDepartment of Medicine, Philadelphia VA Medical Center
  • , Geno J. MerliAffiliated withJefferson Vascular Center, Thomas Jefferson University
  • , Walter K. KraftAffiliated withJefferson Vascular Center, Thomas Jefferson University

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The optimal method of thromboprophylaxis and the value of screening ultrasonography for detection of deep venous thrombosis (DVT) in neurosurgery patients remains unclear. The goal of this study was to determine the incidence of DVT in neurosurgical patients who, by hospital protocol, receive surveillance ultrasonography of the lower extremities twice weekly, in addition to prophylaxis with unfractionated heparin and external pneumatic compression sleeves. A retrospective review of 7,298 ultrasound studies carried out on 2,593 patients over 4 years at a university neurosurgical hospital was conducted. There was a 7.4% incidence of proximal lower extremity DVT and a 9.7% total incidence including distal DVT. A greater number of distal DVTs were detected with the implementation of whole-leg ultrasonography in the last 2 years of observation. Chart review of 237 patients diagnosed with DVT demonstrated an admitting diagnosis of subarachnoid hemorrhage in nearly half of the patients. The median hospital length of stay for DVT patients was 18 days. Institutional control data demonstrated non-ruptured aneurysm and cerebrovascular anomalies to be the leading reason for admission, followed closely by subarachnoid hemorrhage. The hospital protocol of biweekly screening ultrasound and dual modality prophylaxis for neurosurgery patients resulted in a proximal DVT incidence consistent with that demonstrated by previous studies of standardized dual modality prophylaxis, and higher than that demonstrated in previous studies that employed ultrasound screening protocols.


Neurosurgery Ultrasound Deep vein thrombosis Prophylaxis Screening