Journal of Thrombosis and Thrombolysis

, Volume 43, Issue 1, pp 98–104 | Cite as

Impact of practice change in reducing venous thromboembolism in neurocritical overweight patients: 2008–2014

  • Sophie Samuel
  • Suhas Bajgur
  • Jude P. Savarraj
  • Huimahn A. Choi


Publications regarding early initiating venous thromboembolism (VTE) prophylaxis have been available since the early 1990s. These recommendations became available in current guidelines on and after 2012. The purpose of this study is to review the practice change in reducing the incidence of VTE in brain injury patients from 2008 to 2014. This was a single-center, retrospective, observational, cohort study. Data was extracted from our data base that included patients over 100 kg from January 2008 to August 2014. Included were all patients admitted with a primary diagnosis of acute brain and spinal injury to neurocritical care unit. Clinical endpoints examined were incidence of bleeding and VTE. A total of 509 patients who met the inclusion criteria were divided into two groups: The previous group (n = 212) included patients from 2008 to 2010, and the recent group (n = 297) included patients from 2011 to 2014. The time for initiating VTE prophylaxis from admission was (median, IQR) 73 h (37–140) vs. 34 h (20–46); p < 0.01. There were no differences in major and minor bleeding complications. Discontinuation of VTE prophylaxis for association with progressive bleeding was not documented in any of the study patients. The incidence of VTE was 10 % (22/212) vs. 5 % (15/297); p = 0.02. In hospital LOS in days was 16 (10–26) vs. 7 (4–15); P < 0.01. In multivariable logistic regression analysis, only the time of the initiation VTE prophylaxis after admission was significantly associated with the occurrence of VTE (median, IQR) 70 h (37–158) vs. 36 h (20–63); OR 1.004, 95 % CI 1.001–1.007; P < 0.01. In this 6-year review of data, early initiation of VTE prophylaxis has decreased the incidence of VTE without clinically documented bleeding complications.


Heparin Neurosurgery Risk factors Venous thromboembolism 


  1. 1.
    Frim DM, Barker FG, Poletti CE, Hamilton AJ (1992) Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery 30:830–832 (discussion 832–3)CrossRefPubMedGoogle Scholar
  2. 2.
    Hamilton MG, Hull RD, Pineo GF (1994) Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:280–296 (discussion 296)CrossRefPubMedGoogle Scholar
  3. 3.
    Goldhaber SZ, Dunn K, Gerhard-Herman M et al (2002) Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 122:1933–1937CrossRefPubMedGoogle Scholar
  4. 4.
    Skaf E, Stein PD, Beemath A et al (2005) Venous thromboembolism in patients with ischemic and hemorrhagic stroke. Am J Cardiol 96:1731–1733. doi:10.1016/j.amjcard.2005.07.097 CrossRefPubMedGoogle Scholar
  5. 5.
    Kappelle LJ (2011) Preventing deep vein thrombosis after stroke: strategies and recommendations. Curr Treat Options Neurol 13:629–635. doi:10.1007/s11940-011-0147-4 CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Phelan HA (2012) Pharmacologic venous thromboembolism prophylaxis after traumatic brain injury: a critical literature review. J Neurotrauma 29:1821–1828. doi:10.1089/neu.2012.2459 CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Kiphuth IC, Staykov D, Köhrmann M et al (2009) Early administration of low molecular weight heparin after spontaneous intracerebral hemorrhage. A safety analysis. Cerebrovasc Dis 27:146–150. doi:10.1159/000177923 CrossRefPubMedGoogle Scholar
  8. 8.
    Wu T-C, Kasam M, Harun N et al (2011) Pharmacological deep vein thrombosis prophylaxis does not lead to hematoma expansion in intracerebral hemorrhage with intraventricular extension. Stroke 42:705–709. doi:10.1161/STROKEAHA.110.600593 CrossRefPubMedGoogle Scholar
  9. 9.
    Raabe A, Gerlach R, Zimmermann M, Seifert V (2001) The risk of haemorrhage associated with early postoperative heparin administration after intracranial surgery. Acta Neurochir 143:1–7CrossRefGoogle Scholar
  10. 10.
    Dickinson LD, Miller LD, Patel CP, Gupta SK (1998) Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 43:1074–1081CrossRefPubMedGoogle Scholar
  11. 11.
    Lacut K, Bressollette L, Le Gal G et al (2005) Prevention of venous thrombosis in patients with acute intracerebral hemorrhage. Neurology 65:865–869. doi:10.1212/01.wnl.0000176073.80532.a2 CrossRefPubMedGoogle Scholar
  12. 12.
    Boeer A, Voth E, Henze T, Prange HW (1991) Early heparin therapy in patients with spontaneous intracerebral haemorrhage. J Neurol Neurosurg Psychiatry 54:466–467CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Dickmann U, Voth E, Schicha H et al (1988) Heparin therapy, deep-vein thrombosis and pulmonary embolism after intracerebral hemorrhage. Klin Wochenschr 66:1182–1183CrossRefPubMedGoogle Scholar
  14. 14.
    Mesa-Galán LA, Egea-Guerrero JJ, Vilches-Arenas A, Quintana-Diaz M (2016) The effectiveness and safety of pharmacological prophylaxis against venous thromboembolism in patients with moderate-to-severe traumatic brain injury: a systematic review and meta-analysis. J Trauma Acute Care Surg. doi:10.1097/TA.0000000000001134 PubMedGoogle Scholar
  15. 15.
    Samuel S, Iluonakhamhe EK, Adair E et al (2015) High dose subcutaneous unfractionated heparin for prevention of venous thromboembolism in overweight neurocritical care patients. J Thromb Thrombolysis 40:302–307. doi:10.1007/s11239-015-1202-x CrossRefPubMedGoogle Scholar
  16. 16.
    Jauch EC, Saver JL, Adams HP et al (2013) Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 44:870–947. doi:10.1161/STR.0b013e318284056a CrossRefPubMedGoogle Scholar
  17. 17.
    Lansberg MG, O’Donnell MJ, Khatri P et al (2012) Antithrombotic and thrombolytic therapy for ischemic stroke: antithrombotic therapy and prevention of thrombosis, 9th ed: American college of chest physicians evidence-based clinical practice guidelines. Chest 141:e601S–e601S36S. doi:10.1378/chest.11-2302 CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Hemphill JC, Greenberg SM, Anderson CS et al (2015) Guidelines for the management of spontaneous intracerebral hemorrhage. Stroke 46:2032–2060. doi:10.1161/STR.0000000000000069 CrossRefPubMedGoogle Scholar
  19. 19.
    Connolly ES, Rabinstein AA, Carhuapoma JR et al (2012) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a guideline for healthcare professionals from the American Heart Association/american Stroke Association. Stroke 43:1711–1737. doi:10.1161/STR.0b013e3182587839 CrossRefPubMedGoogle Scholar
  20. 20.
    Nyquist P, Bautista C, Jichici D et al (2016) Prophylaxis of venous thrombosis in neurocritical care patients: an evidence-based guideline: a statement for healthcare professionals from the neurocritical care society. Neurocrit Care 24:47–60. doi:10.1007/s12028-015-0221-y CrossRefPubMedGoogle Scholar
  21. 21.
    Ann M guidelines for the management of severe traumatic brain injury 3rd EditionGoogle Scholar
  22. 22.
    Joy M, Tharp E, Hartman H et al (2016) Safety and efficacy of high-dose unfractionated heparin for prevention of venous thromboembolism in overweight and obese patients. Pharmacotherapy. doi:10.1002/phar.1775 PubMedGoogle Scholar
  23. 23.
    Cohen AT, Spiro TE, Büller HR et al (2013) Rivaroxaban for thromboprophylaxis in acutely Ill medical patients. N Engl J Med 368:513–523. doi:10.1056/NEJMoa1111096 CrossRefPubMedGoogle Scholar
  24. 24.
    Wang T-F, Milligan PE, Wong CA et al (2014) Efficacy and safety of high-dose thromboprophylaxis in morbidly obese inpatients. Thromb Haemost 111:88–93. doi:10.1160/TH13-01-0042 CrossRefPubMedGoogle Scholar
  25. 25.
    Henwood PC, Kennedy TM, Thomson L et al (2011) The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis. J Thromb Thrombolysis 32:209–214. doi:10.1007/s11239-011-0583-8 CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Sophie Samuel
    • 1
  • Suhas Bajgur
    • 2
  • Jude P. Savarraj
    • 2
  • Huimahn A. Choi
    • 2
  1. 1.Department of PharmacyMemorial Hermann-Texas Medical CenterHoustonUSA
  2. 2.Department of Neurosurgery and NeurologyThe University of Texas Medical School at HoustonHoustonUSA

Personalised recommendations