Safety of deep venous thrombosis prophylaxis with low-molecular-weight heparin in brain surgery. Prospective study on 746 patients

Background: Pharmacologic prophylaxis of deep vein thrombosis for intracranial surgery is still a controversial matter due to the concern of possible increased risk of postoperative hemorrhage. The objective of this prospective study was to assess the safety of the deep vein thrombosis prophylaxis protocol applied in Our neurosurgical unit. Methods: This is a prospective clinical trial on 746 consecutive patients undergoing intracranial surgery during a 30-month period managed by our deep vein thrombosis prophylaxis protocol. All patients were managed with elastic stockings, perioperative mechanical pneumatic sequential compression leg device, and 3500 units (daily) of sodium Tinzaparin starting from the first postoperative day. In those patients who were considered to be at higher risk to develop deep vein thrombosis, the dose of heparin was doubled and was started in the preoperative period. Results: Eight (1.07%) significant postoperative hemorrhages were recorded among 746 procedures, 6 (0.8%) of those occurred among patients undergoing major cranial procedures. Clinical evidence of deep vein thrombosis was present in 3 patients (0.4%). One patient (0.13%) died of fatal PE 2 months after surgery. Conclusion: The results of this study show the safety of our deep vein thrombosis prevention protocol in patients undergoing intracranial neurosurgical operation. (C) 2008 Elsevier Inc. All rights reserved.