[Thromboprophylaxis in neurosurgery and head trauma].
The incidence of deep vein thrombosis (DVT) is between 20 and 35% using contrast venography, with a rate of symptomatic DVT between 2.3 and 6% in neurosurgery without any prophylaxis. The risk of DVT is poorly evaluated in head injured patients but is around 5%. Specific risk factors in neurosurgery are: a motor deficit, a meningioma or malignant tumour, a large tumour, age over 60 years, surgery lasting more than 4 hours, a chemotherapy. The benefit of mechanical methods or low molecular weight heparin (LMWH) for the prevention of DVP in neurosurgery is demonstrated (grade A). Each method decreases the risk by about 50%. A postoperative prophylaxis with a LMWH does not seem to increase the risk of intracranial bleeding (grade C). There is no demonstrated benefit to begin a prophylaxis with LMWH before the intervention. The duration of the prophylaxis is 7 to 10 days but this has not been scientifically determined.
Payen
J-F
JF
Département d'anesthésie-réanimation 1, CHU de Grenoble, France.
Faillot
T
T
Audibert
G
G
Vergnes
M-C
MC
Bosson
J-L
JL
Lestienne
B
B
Bernard
C
C
Bruder
N
N
D006259:Craniocerebral Trauma / Q000150:complications* / Q000628:therapy; D006801:Humans; D019635:Neurosurgical Procedures; D018570:Risk Assessment; D013923:Thromboembolism / Q000517:prevention & control*