Neuro/Spine

Asymptomatic deep vein thrombosis (DVT) has been reported in up to 60-100% of persons with spinal cord injury. Pulmonary embolism (PE) has been reported in up to 5% and is the third leading cause of death in all patients during the first year after injury. DVT usually occurs during the first two weeks after injury, but the risks remain even when a patient moves on to a rehabilitation facility.

The incidence of DVT in neurosurgical patients can be as high as 25% with 1% percent developing PE. Patients are at increased risk if they have undergone prolonged surgeries, have limb weakness, or will be on prolonged bed rest. In patients that have had a craniotomy, stroke, or surgery for brain tumor the use of low molecular weight heparin in DVT prevention increases the patient’s risk of intracranial hemorrhage (ICH). Talk to your doctor about your risk and ways to prevent DVT and PE with spinal cord injury, spine or neurosurgery.

Additional Risks

• Male
• Complete Motor Injuries
• Paraplegia (impairment of the lower extremities)
• Long Bone or Pelvic Fractures
• >55 Years Old
• Prior DVT or PE
• Obesity
• Malignancy
• Blood Clotting Disorders

Prevention

• Low Molecular Weight Heparin (LMWH)
• Intermittent Pneumatic Compression Devices
• Compression Stockings
• IVC Filter

Recommendations

• LMWH is the preferred agent if hemostasis is present in patients with spinal cord injury.
• IVC filters should be considered in patients with complete motor paralysis caused by lesions in the high cervical cord, with poor cardiopulmonary reserve, or with thrombus in the inferior vena cava despite anticoagulation. IVC filters can prevent lower extremity DVT from becoming a PE in up to 98% of patients.
• The incidence of post-operative DVT and PE may be significantly reduced using mechanical prophylaxis alone since there is an increased risk of ICH with LMWH or unfractionated heparin use.

References

• Johns J, Nguyen C, Sing R. Vena Cava Filters in Spinal Cord Injuries: Evolving Technology. J Spinal Cord Med. 2006;29:183-190.
• Prophylaxis for Deep Venous Thrombosis in Craniotomy Patients: A Decision Analysis. Shabbar F. Danish, Mark G. Burnett, Seema S. Sonnad, Eileen Maloney-Wilensky, Joseph Ong, and Sherman C. Stein. Neurosurgery. 2005 Jun; 56 (6): 1286-92; discussion 1292-4.
• Smith SF, Biggs MT, Sekhon LH. Risk Factors and Prophylaxis for Deep Vein Thrombosis in Neurosurgery. Surg Technol Int. 2005;14:69-76.
• Epstien, Nancy. A Review of the Risks and Benefits of Differing Prophylaxis Regimens for the Treatment of Deep Vein Thrombosis and Pulmonary Embolism in Neurosurgery. Surgical Neurology. 2005 Oct; 64 (4): 295-301.
• Payen, JF, et al. Thromboprophylaxis in Neurosurgery and Head Trauma. Ann Fr Anesth Reanim. 2005 Aug; 24(8): 921-7.