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Deep Venous Thrombosis and Venous Thromboembolism Prevention in the Neurocritical Care Unit

  • Lucido L. Ponce Mejia
  • Paul NyquistEmail author
Chapter

Abstract

Venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism (PE) is a life-threatening complication in critically ill neurological and neurosurgical patients. The incidence of deep venous thrombosis in this population has been reported to be as high as 34% when prophylaxis was not given. Pulmonary embolism is the primary cause of death in half of these patients. Risk factors for VTE in this population include delayed ambulation due to paralysis or coma, lengthy hospital stays, and length of neurosurgical procedures. Also, brain tumors, inflammatory diseases of the nervous system, and stroke lead to vascular endothelium activation. There is a wide variability in clinical practice for VTE prophylaxis in these patients, partly due to paucity of data based on randomized clinical trials. The lack of evidence has led to the publication of evidence-based guidelines. The available evidence supports the use of mechanical and chemical VTE prophylaxis as beneficial in reducing the risk of developing DVT and PE; unfortunately, the risk of hemorrhagic complications when starting chemical prophylaxis remains a substantial concern for health-care providers.

It is useful to know the risk of DVT and PE in specific subpopulations of neurosurgery and neurology patients as different neurological diseases carry various degrees of risk for VTE and hemorrhage.

Keywords

Venous thromboembolism (VTE) Deep venous thrombosis (DVT) Pulmonary embolism (PE) Mechanical prophylaxis Pharmacologic prophylaxis Critically ill Neurocritical care Hemorrhage 

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© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  1. 1.Department of Anesthesia and Critical Care MedicineThe Johns Hopkins School of MedicineBaltimoreUSA

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