Is anticoagulation for venous thromboembolism safe for Asian elective neurosurgical patients? A single centre study.

Background: The incidence of venous thromboembolism (VTE) in neurosurgical patients ranges 3-24%. VTE is potentially fatal, and prophylactic anticoagulation is recommended worldwide. However, anticoagulation poses a risk of haemorrhage, which can be devastating. We aim to determine the incidence of VTE and risk of haemorrhage following anticoagulation.

Methods: Between 1 May 2014 and 1 May 2016, all patients who underwent elective neurosurgery were recruited into our study. All patients had bilateral lower limb ultrasound to screen for deep vein thrombosis (DVT) between post-operative days 3 and 7. These patients are also monitored for manifestations of pulmonary embolism (PE). If present, a computed tomography pulmonary angiogram will be performed. Patients with VTE will either receive conservative treatment or anticoagulation.

Results: During this period, 170 of 610 patients were included. Of the 170 patients, 17 patients (10.0%) developed DVT. Fifteen patients had cranial surgery and two patients had spinal surgery. Two patients (1.2%) developed PE and both patients had concurrent DVT. Of these 17 patients, nine patients received anticoagulation. Of these nine patients, six patients (66.7%) developed surgical site bleeding following anticoagulation and all of them required surgical intervention. Patients who were managed conservatively did not suffer haemorrhage.

Conclusion: Our results show an overall 10.0% incidence of DVT and 1.2% incidence of PE following elective neurosurgery within this Asian cohort of neurosurgical patients. There is also a high risk (66.7%) of significant surgical site bleeding following anticoagulation.