title: The risk of haemorrhage associated with early postoperative heparin administration after intracranial surgery.
abstract: BACKGROUND
  To analyse the rate of postoperative haemorrhage during a 4-year period of early postoperative administration (< 24 hours) of fractionated heparin plus compression stockings in a large cohort of patients undergoing intracranial surgery.
  
  
  METHODS
  A total of 1564 patients who underwent intracranial surgery at our institution were included in our study. 1197 of the 1564 patients (77%) had major intracranial surgery (group 1). Group 2 was made up of 367 patients in whom ventriculoperitoneal shunting or external ventriculostomy was performed (minor intracranial procedures). All patients were investigated retrospectively for the occurrence of major postoperative haemorrhage confirmed by CT scanning and requiring surgical evacuation. The protocol for prophylaxis of thrombo-embolic events included early (< 24 hours) postoperative fractionated low-dose heparin (3 x 5000 IE subcutaneously) until discharge plus intra- and postoperative compression stockings.
  
  
  RESULTS
  Major postoperative haemorrhages were observed in 31 of the 1564 patients (2.0%). In three patients, the haemorrhage occurred on the day of surgery before the administration of heparin. The haemorrhage rate of patients receiving heparin was 1.8% (28/1564). All haemorrhages occurred in patients undergoing major intracranial procedures (group 1; 31/1197; 2.6%). There was no haemorrhage in minor intracranial procedures (group 2; 0/367; 0%).
  
  
  CONCLUSIONS
  Although retrospective, this is to date the largest study supporting the concept of postoperative pharmacological thrombo-embolic propylaxis in patients undergoing intracranial surgery. The question as to whether pharmacological prophylaxis is beneficial for a given patient can only be answered by weighing the risk reduction of thrombo-embolic events against the risk increase of postoperative haemorrhage associated with different surgical procedures and heparin protocols.
authors.affiliation: Department of Neurosurgery, Johann Wolfgang Goethe University, Frankfurt am Main, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Raabe
authors.forename: R
authors.initials: R
authors.lastname: Gerlach
authors.forename: M
authors.initials: M
authors.lastname: Zimmermann
authors.forename: V
authors.initials: V
authors.lastname: Seifert
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001458:Bandages; D001932:Brain Neoplasms / Q000601:surgery*; D002543:Cerebral Hemorrhage / Q000139:chemically induced* / Q000601:surgery; D002557:Cerebrospinal Fluid Shunts; D002561:Cerebrovascular Disorders / Q000601:surgery*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D006493:Heparin / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D019106:Postoperative Hemorrhage / Q000139:chemically induced* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013923:Thromboembolism / Q000517:prevention & control*; D014696:Ventriculostomy
chemical_list: D006493:Heparin