Prophylaxis against thromboembolism in neurosurgical patients: a survey of current practice in the United Kingdom

Venous thromboembolism is a life threatening, but preventable complication of major surgery. Many neurosurgical patients are at high risk of developing thromboembolic disease. A postal survey was undertaken of 44 UK neurosurgical centres to assess the use of physical and pharmacological methods of prophylaxis against thromboembolism. Thirty-five replies were received from 31 centres. Seventy-seven per cent of units used antiembolism stockings (TEDs) for elective surgery and 37% for emergency surgery; in approximately two-thirds of these units TEDs constituted the sole method of prophylaxis used during both elective and emergency surgery. Intermittent pneumatic compression (IPC) was utilized in 37 and 11% of units for elective and emergency surgery, respectively. Subcutaneous heparin was used in 32% of units perioperatively including 6% of emergency cases. These findings suggest that neurosurgical patients, who are at moderate to high risk of developing thromboembolic complications, may not receive effective prophylaxis; those undergoing emergency neurosurgery are less likely to receive any form of prophylaxis.