title: The incidence of deep venous thrombosis in high-risk Indian neurosurgical patients: Need for early chemoprophylaxis?
abstract: BACKGROUND
  Deep venous thrombosis (DVT) is thought to be less common in Asians than in Caucasian population. The incidence of DVT in high-risk groups, especially the neurosurgical (NS) patients, has not been well studied. This leaves no firm basis for the start of early prophylactic anticoagulation within first 5 postoperative days in Indian NS patients. This is a prospective observational study to determine the early occurrence of DVT in the NS patients.
  
  
  METHODS
  We screened 137 consecutive high-risk NS patients based on inclusion and exclusion criteria. The femoral veins were screened using Doppler ultrasound on day 1, 3, and 5 of admission into the NS Intensive Care Unit (ICU) at tertiary center from South India.
  
  
  RESULTS
  Among 2887 admissions to NICU 147 patients met inclusion criteria. One hundred thirty seven were screened for DVT. There was a 4.3% (6/137) incidence of DVT with none of the six patients having signs or symptoms of pulmonary embolism. Among the risk factors studied, there was a significant association with femoral catheterization and a probable association with weakness/paraparesis/paraplegia. The mortality in the study group was 10.8% with none attributable to DVT or pulmonary embolism.
  
  
  CONCLUSIONS
  There is a low incidence of DVT among the high risk neurosurgical population evaluated within the first 5 days of admission to NICU, limiting the need for early chemical thrombo-prophylaxis in these patients. With strict protocols for mechanical prophylaxis with passive leg exercise, early mobilization and serial femoral Doppler screening, heparin anticoagulation can be restricted within the first 5 days of ICU admission in high risk patients.
authors.affiliation: Department of General Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Ajith John
authors.initials: AJ
authors.lastname: George
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Shalini
authors.initials: S
authors.lastname: Nair
authors.affiliation: Department of General Medicine, Changi General Hospital, Singapore City, Singapore.
authors.forename: Jayanthi Chinnaiya
authors.initials: JC
authors.lastname: Karthic
authors.affiliation: Department of Neurological Sciences, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Mathew
authors.initials: M
authors.lastname: Joseph
keywords: Deep vein thrombosis; duplex ultrasonography; heparin; high-risk neurosurgical patients; mechanical prophylaxis