Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients

D. M. Frim, F. G. Barker, C. E. Poletti, Allan J Hamilton, J. E. Bailes, N. H. Horwitz, H. N. Friedman

Research output: Contribution to journalArticle

87 Citations (Scopus)

Abstract

Thromboembolic complications are a major cause of postoperative morbidity and mortality in the neurosurgical patient. Prophylaxis with lower extremity pneumatic compression boots (PCBs) reduces the incidence of lower extremity deep vein thrombosis (DVT) but has not been shown to affect the incidence of pulmonary embolism (PE). Prophylaxis with low-dose heparin has consistently reduced the incidence of both DVT and PE in studies on general surgical patients but has not been adopted for use in neurosurgery primarily for fear of causing catastrophic hemorrhage. We report on a series of 138 consecutive adult patients who underwent major neurosurgical procedures on a general neurosurgical service at our institution. Patients were treated with intraoperative PCBs and, starting on the morning of the first postoperative day, with a regimen of 5000 U of heparin administered subcutaneously twice daily. This treatment was continued until patients were fully ambulatory. PCBs were discontinued 24 hours after the first administration of heparin. None of the heparin-treated patients suffered postoperative hemorrhage. We compared this series with a control group of 473 adult patients who had previously undergone major neurosurgical procedures on the same neurosurgical service. These patients had been treated with intraoperative and postoperative PCBs alone. The control group had a 3.2% incidence of thromboembolic complications (15 of 473; eight DVT, seven PE). Prophylaxis with PCBs plus heparin significantly (P = 0.020) reduced the incidence of thromboembolic complications: no PCBs/heparin-treated patient exhibited clinical evidence of PE or DVT (0%, 0/138). We conclude that a combination of intraoperative PCBs and postoperative low-dose heparin is a safe and effective method by which to reduce thromboembolic complications in the neurosurgical patient.

Original languageEnglish (US)
Pages (from-to)830-833
Number of pages4
JournalNeurosurgery
Volume30
Issue number6
StatePublished - 1992

Fingerprint

Heparin
Pulmonary Embolism
Venous Thrombosis
Incidence
Neurosurgical Procedures
Lower Extremity
Postoperative Hemorrhage
Control Groups
Neurosurgery
Fear
Hemorrhage
Morbidity
Mortality

Keywords

  • Deep vein thrombosis
  • Low-dose heparin
  • Pneumatic compression boots
  • Pulmonary embolus

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Frim, D. M., Barker, F. G., Poletti, C. E., Hamilton, A. J., Bailes, J. E., Horwitz, N. H., & Friedman, H. N. (1992). Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery, 30(6), 830-833.

Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. / Frim, D. M.; Barker, F. G.; Poletti, C. E.; Hamilton, Allan J; Bailes, J. E.; Horwitz, N. H.; Friedman, H. N.

In: Neurosurgery, Vol. 30, No. 6, 1992, p. 830-833.

Research output: Contribution to journalArticle

Frim, DM, Barker, FG, Poletti, CE, Hamilton, AJ, Bailes, JE, Horwitz, NH & Friedman, HN 1992, 'Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients', Neurosurgery, vol. 30, no. 6, pp. 830-833.
Frim DM, Barker FG, Poletti CE, Hamilton AJ, Bailes JE, Horwitz NH et al. Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. Neurosurgery. 1992;30(6):830-833.
Frim, D. M. ; Barker, F. G. ; Poletti, C. E. ; Hamilton, Allan J ; Bailes, J. E. ; Horwitz, N. H. ; Friedman, H. N. / Postoperative low-dose heparin decreases thromboembolic complications in neurosurgical patients. In: Neurosurgery. 1992 ; Vol. 30, No. 6. pp. 830-833.
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