Venous thromboembolism in patients admitted to a neurosurgical ward: characteristics and anticoagulation in a tertiary hospital

Introduction and objectives: The neurosurgical patients have a high risk of venous thromboembolism (VTE). However, the management is complex due to high risk of serious bleeding. We herein analyse characteristics, treatment and outcome of the neurosurgical patients with VTE in our centre. Methods: Retrospective analysis of medical records from the patients admitted to the Neurosurgery ward and with VTE from 01/01/2017 to 12/31/2021. Results: From 01/01/2017 to 12/31/2021, 13 patients admitted to Neurosurgery ward were diagnosed of VTE (77% male, median age 66 years-old). Most of them were admitted because of CNS tumour or intracranial bleeding. 61% had pulmonary embolism (PE), 23% deep venous thrombosis (DVT) and 15% both. In 7 out of 13 patients ETV occurred after surgery (median, 13 days after) and 4 has a previous diagnosis of VTE (median, 26 days before). Anticoagulation was initiated a median of 12 days after surgery with low molecular weight heparin (LMWH), in most of the cases with an infra-therapeutic dose which was progressively increased to maximum doses a median of 13 days after surgery. No bleeding complication was recorded. Two patients died due to their previous illness. Conclusions: The neurosurgical patients have several risk factors for VTE, which is especially difficult to manage due to the high bleeding risk. In our centre most patients received initially infra-therapeutic doses of LMWH, and no bleeding events occurred. More studies are needed to guide anticoagulation in this population.