Journal of Thrombosis and Thrombolysis

, Volume 32, Issue 2, pp 209–214 | Cite as

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

  • Patricia C. Henwood
  • Thomas M. Kennedy
  • Lynda Thomson
  • Taki Galanis
  • George L. Tzanis
  • Geno J. Merli
  • Walter K. Kraft
Article

Abstract

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.

Keywords

Neurosurgery Ultrasound Deep vein thrombosis Prophylaxis Screening 

Abbreviations

ACCP

American College of Chest Physicians

DVT

Deep vein thrombosis

ICH

Intracranial hemorrhage

JHN

Jefferson Hospital for Neuroscience

LMWH

Low molecular weight heparin

PE

Pulmonary embolism

SAH

Subarachnoid hemorrhage

U

Units

UFH

Unfractionated heparin

VTE

Venous thromboembolism

References

  1. 1.
    The surgeon general’s call to action to prevent deep vein thrombosis and pulmonary embolism (2008). U.S. Department of Health and Human Services. http://www.surgeongeneral.gov/topics/deepvein/calltoaction/call-to-action-on-dvt-2008.pdf. Accessed Nov 6, 2010
  2. 2.
    Geerts WH, Bergqvist D, Pineo GF et al (2008) Prevention of venous thromboembolism: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6):381S–453SPubMedCrossRefGoogle Scholar
  3. 3.
    Hirsh J, Guyatt G, Albers GW, Harrington R, Schunemann HJ, American College of Chest Physician (2008) Antithrombotic and thrombolytic therapy: American College of Chest Physicians evidence-based clinical practice guidelines (8th edition). Chest 133(6 Suppl):110S–112SPubMedCrossRefGoogle Scholar
  4. 4.
    Kakkar AK, Cohen AT, Tapson VF et al (2010) Venous thromboembolism risk and prophylaxis in the acute care hospital setting (ENDORSE survey): findings in surgical patients. Ann Surg 251(2):330–338PubMedCrossRefGoogle Scholar
  5. 5.
    Deitelzweig SB, Lin J, Hussein M, Battleman D (2009) Are surgical patients at risk of venous thromboembolism currently meeting the Surgical Care Improvement Project performance measure for appropriate and timely prophylaxis? J Thromb Thrombolysis 30(1):55–66CrossRefGoogle Scholar
  6. 6.
    Black PM, Baker MF, Snook CP (1986) Experience with external pneumatic calf compression in neurology and neurosurgery. Neurosurgery 18(4):440–444PubMedCrossRefGoogle Scholar
  7. 7.
    Anderson FA Jr, Spencer FA (2003) Risk factors for venous thromboembolism. Circulation 107(23 Suppl 1):I9–I16PubMedGoogle Scholar
  8. 8.
    Agnelli G, Piovella F, Buoncristiani P et al (1998) Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339(2):80–85PubMedCrossRefGoogle Scholar
  9. 9.
    Iorio A, Agnelli G (2000) Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med 160(15):2327–2332PubMedCrossRefGoogle Scholar
  10. 10.
    Goldhaber SZ, Dunn K, Gerhard-Herman M, Park JK, Black PM (2002) Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 122(6):1933–1937PubMedCrossRefGoogle Scholar
  11. 11.
    Gnanalingham KK, Holland JP (2003) Attitudes to the use of prophylaxis for thrombo-embolism in neurosurgical patients. J Clin Neurosci 10(4):467–469PubMedCrossRefGoogle Scholar
  12. 12.
    Danish SF, Burnett MG, Ong JG, Sonnad SS, Maloney-Wilensky E, Stein SC (2005) Prophylaxis for deep venous thrombosis in craniotomy patients: a decision analysis. Neurosurgery 56(6):1286–1294PubMedCrossRefGoogle Scholar
  13. 13.
    Collen JF, Jackson JL, Shorr AF, Moores LK (2008) Prevention of venous thromboembolism in neurosurgery: a metaanalysis. Chest 134(2):237–249PubMedCrossRefGoogle Scholar
  14. 14.
    Nurmohamed MT, van Riel AM, Henkens CM et al (1996) Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery. Thromb Haemost 75(2):233–238PubMedGoogle Scholar
  15. 15.
    Bernardi E, Camporese G, Buller HR et al (2008) Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA 300(14):1653–1659PubMedCrossRefGoogle Scholar
  16. 16.
    MacDonald PS, Kahn SR, Miller N, Obrand D (2003) Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 37:523–527PubMedCrossRefGoogle Scholar
  17. 17.
    Gillet JL, Perrin MR, Allaert FA (2007) Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg 46:513–519PubMedCrossRefGoogle Scholar
  18. 18.
    Misra M, Roitberg B, Ebersole K, Charbel FT (2004) Prevention of pulmonary embolism by combined modalities of thromboprophylaxis and intensive surveillance protocol. Neurosurgery 54(5):1099–1103PubMedCrossRefGoogle Scholar
  19. 19.
    Flinn WR, Sandager GP, Silva MB Jr, Benjamin ME, Cerullo LJ, Taylor M (1996) Prospective surveillance for perioperative venous thrombosis: experience in 2643 patients. Arch Surg 131(5):472–480PubMedGoogle Scholar
  20. 20.
    Ray WZ, Strom RG, Blackburn SL, Ashley WW, Sicard GA, Rich KM (2009) Incidence of deep venous thrombosis after subarachnoid hemorrhage. J Neurosurg 110(5):1010–1014PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Patricia C. Henwood
    • 1
  • Thomas M. Kennedy
    • 2
  • Lynda Thomson
    • 2
  • Taki Galanis
    • 2
  • George L. Tzanis
    • 3
  • Geno J. Merli
    • 2
  • Walter K. Kraft
    • 2
  1. 1.Department of Emergency MedicineBrigham and Women’s HospitalBostonUSA
  2. 2.Jefferson Vascular CenterThomas Jefferson UniversityPhiladelphiaUSA
  3. 3.Department of MedicinePhiladelphia VA Medical CenterPhiladelphiaUSA

Personalised recommendations