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Neurocritical Care

, Volume 24, Issue 1, pp 47–60 | Cite as

Prophylaxis of Venous Thrombosis in Neurocritical Care Patients: An Evidence-Based Guideline: A Statement for Healthcare Professionals from the Neurocritical Care Society

  • Paul NyquistEmail author
  • Cynthia Bautista
  • Draga Jichici
  • Joseph Burns
  • Sanjeev Chhangani
  • Michele DeFilippis
  • Fernando D. Goldenberg
  • Keri Kim
  • Xi Liu-DeRyke
  • William Mack
  • Kim Meyer
Review Article

Abstract

The risk of death from venous thromboembolism (VTE) is high in intensive care unit patients with neurological diagnoses. This is due to an increased risk of venous stasis secondary to paralysis as well as an increased prevalence of underlying pathologies that cause endothelial activation and create an increased risk of embolus formation. In many of these diseases, there is an associated risk from bleeding because of standard VTE prophylaxis. There is a paucity of prospective studies examining different VTE prophylaxis strategies in the neurologically ill. The lack of a solid evidentiary base has posed challenges for the establishment of consistent and evidence-based clinical practice standards. In response to this need for guidance, the Neurocritical Care Society set out to develop and evidence-based guideline using GRADE to safely reduce VTE and its associated complications.

Keywords

Venous thrombus Stroke Subarachnoid hemorrhage Traumatic brain injury Intracranial hemorrhage Pulmonary embolus 

Abbreviations

VTE

Venous thromboembolism

DVT

Deep venous thrombus

PE

Pulmonary embolus

NICU

Neurological intensive care unit

ICU

Intensive care unit

aSAH

Aneurysmal subarachnoid hemorrhage

ICH

Intracranial hemorrhage

tICH

Traumatic intracranial hemorrhage

IS

Ischemic stroke

TBI

Traumatic brain Injury

SCI

Spinal cord injury

UFH

Unfractionated heparin

LMWH

Low-molecular-weight heparin

IPC

Intermittent pneumatic compression

CS

Compression stockings

IVF

Inferior venous-caval filter

Notes

Conflict of interest

All of the authors declare that they have no conflicts of interest.

Supplementary material

12028_2015_221_MOESM1_ESM.docx (224 kb)
Supplementary material 1 (DOCX 224 kb)

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Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Paul Nyquist
    • 1
    Email author
  • Cynthia Bautista
    • 2
  • Draga Jichici
    • 3
  • Joseph Burns
    • 4
  • Sanjeev Chhangani
    • 5
  • Michele DeFilippis
    • 6
  • Fernando D. Goldenberg
    • 7
  • Keri Kim
    • 8
  • Xi Liu-DeRyke
    • 9
  • William Mack
    • 10
  • Kim Meyer
    • 11
  1. 1.Departments of Neurology, Anesthesia/Critical Care Medicine, Neurosurgery, and General Internal MedicineJohn Hopkins School of MedicineBaltimoreUSA
  2. 2.Department of Nursing, Neuroscience CNSYale-New Haven HospitalNew HavenUSA
  3. 3.Department of Neurology and Critical CareMcMaster UniversityHamiltonCanada
  4. 4.Department of NeurologyLahey Hospital and Medical CenterBurlingtonUSA
  5. 5.Department of AnesthesiaCritical Care and Pain MedicineBostonUSA
  6. 6.Department of NursingMorristown Medical CenterMorristownUSA
  7. 7.Department of NeurologyThe University of Chicago MedicineChicagoUSA
  8. 8.Department of NeurosurgeryUniversity of Illinois Hospital & Health Sciences SystemChicagoUSA
  9. 9.Division of Surgical Critical CareOrlando Regional Medical CenterOrlandoUSA
  10. 10.Department of NeurosurgeryLos Angeles County University Southern California Medical CenterLos AngelesUSA
  11. 11.Department of NeurosurgeryUniversity of Louisville PhysiciansLouisvilleUSA

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