VTE risk, Incidence, and risk associated with prophylaxis in neurosurgical patients.

Background: VTE is highly prevalent within the neurosurgical patient population and therefore a major concern for patients undergoing neurosurgery. VTE prophylaxis use has varied from centre to centre due to concerns of post-operative haemorrhage having catastrophic consequences. Objective: To complete a literature review assessing different VTE risk factors, incidence of VTE associated with different methods of prophylaxis (chemical and mechanical) and the risks associated with use of prophylaxis in neurosurgical patients. Methods: A number of databases including pubmed, Cochrane library, ScienceDirect and Ovid were searched for literature regarding VTE risk factors, VTE incidence and prophylactic risks in neurosurgery. Results: Five studies regarding VTE risk factors were identified. Of the 10,437 patients who developed a VTE pre-op, risk factors such as immobility, older age, hypertension and sepsis were associated with an increased risk of VTE development. Five studies regarding VTE incidence with prophylaxis indicated that VTE incidence is reduced with the addition of prophylaxis in both spinal and cranial surgery patients. Chemoprophylaxis use showed a decreased incidence of 21.5%-25.8% to 12.22%-12.58% in brain surgery patients and a decrease from 1.22% to 0.8% in spinal patients. Mechanical prophylaxis also showed a decreased incidence from 19.8% to 8.8%-9% in neurosurgical patients. Results from three studies regarding bleeding risk associated with prophylaxis showed an increase from 1.5%-1.6% to 2.54%-2.7% in major intracranial haemorrhage and a 0%-0.7% risk of epidural haematoma in spinal surgery patients. Conclusion: A number of risk factors need to be accounted for in prophylaxis guideline decision making. Chemoprophylaxis and mechanical prophylaxis reduce the incidence of VTE development in neurosurgical patients. The risk of bleeding with chemoprophylaxis appears to be slightly increased but this requires further study due to the range of different prophylaxis drugs, dosages and time frames used between different studies.