Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 20 , ISSUE 7 ( 2016 ) > List of Articles

BRIEF COMMUNICATION

The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?

Mathew Joseph, Shalini Nair, Ajith John George, Jayanthi Chinnaiya Karthic

Keywords : Deep vein thrombosis, duplex ultrasonography, heparin, high-risk neurosurgical patients, mechanical prophylaxis

Citation Information : Joseph M, Nair S, George AJ, Karthic JC. The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?. Indian J Crit Care Med 2016; 20 (7):412-416.

DOI: 10.4103/0972-5229.186223

License: CC BY-ND 3.0

Published Online: 01-07-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Introduction: Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT in high-risk groups, especially the neurosurgical (NS) patients, has not been well studied. This leaves no firm basis for the start of early prophylactic anticoagulation within first 5 postoperative days in Indian NS patients. This is a prospective observational study to determine the early occurrence of DVT in the NS patients. Patients and Methods: We screened 137 consecutive high-risk NS patients based on inclusion and exclusion criteria. The femoral veins were screened using Doppler ultrasound on day 1, 3, and 5 of admission into the NS Intensive Care Unit (ICU) at tertiary center from South India. Results: Among 2887 admissions to NICU 147 patients met inclusion criteria. One hundred thirty seven were screened for DVT. There was a 4.3% (6/137) incidence of DVT with none of the six patients having signs or symptoms of pulmonary embolism. Among the risk factors studied, there was a significant association with femoral catheterization and a probable association with weakness/paraparesis/paraplegia. The mortality in the study group was 10.8% with none attributable to DVT or pulmonary embolism. Conclusion: There is a low incidence of DVT among the high risk neurosurgical population evaluated within the first 5 days of admission to NICU, limiting the need for early chemical thrombo-prophylaxis in these patients. With strict protocols for mechanical prophylaxis with passive leg exercise, early mobilization and serial femoral Doppler screening, heparin anticoagulation can be restricted within the first 5 days of ICU admission in high risk patients.


PDF Share
  1. Jaffer AK. An overview of venous thromboembolism: Impact, risks, and issues in prophylaxis. Cleve Clin J Med 2008;75 Suppl 3:S3-6.
  2. Bryson DJ, Uzoigwe CE, Braybrooke J. Thromboprophylaxis in spinal surgery: A survey. J Orthop Surg Res 2012;7:14.
  3. Khaldi A, Helo N, Schneck MJ, Origitano TC. Venous thromboembolism: Deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg 2011;114:40-6.
  4. Agarwal S, Lee AD, Raju RS, Stephen E. Venous thromboembolism: A problem in the Indian/Asian population? Indian J Urol 2009;25:11-6.
  5. Sharma SK, Gupta V, Kadhiravan T, Banga A, Seith A, Kumar A, et al. A prospective study of risk factor profile & incidence of deep venous thrombosis among medically-ill hospitalized patients at a tertiary care hospital in northern India. Indian J Med Res 2009;130:726-30.
  6. Patel AP, Koltz MT, Sansur CA, Gulati M, Hamilton DK. An analysis of deep vein thrombosis in 1277 consecutive neurosurgical patients undergoing routine weekly ultrasonography. J Neurosurg 2013;118:505-9.
  7. Sobieraj-Teague M, Hirsh J, Yip G, Gastaldo F, Stokes T, Sloane D, et al. Randomized controlled trial of a new portable calf compression device (Venowave) for prevention of venous thrombosis in high-risk neurosurgical patients. J Thromb Haemost 2012;10:229-35.
  8. Browd SR, Ragel BT, Davis GE, Scott AM, Skalabrin EJ, Couldwell WT. Prophylaxis for deep venous thrombosis in neurosurgery: A review of the literature. Neurology Focus 2013;17:1-6.
  9. Zweibel WJ. Introduction to vascular ultrasonography. Philadelphia: WB, Saunders: 1992. p. 253-332.
  10. Cronan JJ. Ultrasound evaluation of deep venous thrombosis. Semin Roentgenol 1992;27:39-52.
  11. Henwood PC, Kennedy TM, Thomson L, Galanis T, Tzanis GL, Merli GJ, et al. The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis. J Thromb Thrombolysis 2011;32:209-14.
  12. Christie S, Thibault-Halman G, Casha S. Acute pharmacological DVT prophylaxis after spinal cord injury. J Neurotrauma 2011;28:1509-14.
  13. Dermody M, Alessi-Chinetti J, Iafrati MD, Estes JM. The utility of screening for deep venous thrombosis in asymptomatic, non-ambulatory neurosurgical patients. J Vasc Surg 2011;53:1309-15.
  14. Chung SB, Lee SH, Kim ES, Eoh W. Incidence of deep vein thrombosis after spinal cord injury: A prospective study in 37 consecutive patients with traumatic or nontraumatic spinal cord injury treated by mechanical prophylaxis. J Trauma 2011;71:867-70.
  15. O′Connell S, Bashar K, Broderick BJ, Sheehan J, Quondamatteo F, Walsh SR, et al. The use of intermittent pneumatic compression in orthopedic and neurosurgical postoperative patients: A systematic review and meta-analysis. Ann Surg 2015;263:888-9.
  16. Wang TY, Sakamoto JT, Nayar G, Suresh V, Loriaux DB, Desai R, et al. Independent Predictors of 30-day perioperative deep vein thrombosis in 1346 consecutive patients after spine surgery. World Neurosurg 2015;84:1605-12.
  17. Brambilla S, Ruosi C, La Maida GA, Caserta S. Prevention of venous thromboembolism in spinal surgery. Eur Spine J 2004;13:1-8.
  18. CLOTS Trials Collaboration, Dennis M, Sandercock P, Reid J, Graham C, Murray G, et al. The effect of graduated compression stockings on long-term outcomes after stroke: The CLOTS trials 1 and 2. Stroke 2013;44:1075-9.
  19. Vignon P, Dequin PF, Renault A, Mathonnet A, Paleiron N, Imbert A, et al. Intermittent pneumatic compression to prevent venous thromboembolism in patients with high risk of bleeding hospitalized in intensive care units: The CIREA1 randomized trial. Intensive Care Med 2013;39:872-80.
  20. Rachinger JC, Koman G, Scheller C, Prell J, Rampp S, Strauss C. Practice in the perioperative prevention of deep vein thrombosis in German neurosurgical departments: Is there a trend towards homogenization? Cent Eur Neurosurg 2011;72:115-9.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.