Rachinger J C, Koman G, Scheller C, Prell J, Rampp S, Strauss C
University of Halle-Wittenberg, Neurosurgery, Germany.
Cent Eur Neurosurg. 2011 Aug;72(3):115-9. doi: 10.1055/s-0031-1280791. Epub 2011 Jul 27.
There was no consensus on the most suitable perioperative prophylaxis of deep vein thrombosis (DVT) in neurosurgical patients. The aim of this work was to review the current practice and search for a standard protocol in the prophylaxis of DVT.
Questionnaires addressing the routine prophylaxis of perioperative DVT for 4 groups of neurosurgical procedures and the estimation of risks and benefits of perioperative heparin (unfractionated and/or low-molecular-weight) administration were sent to 130 neurosurgical departments in Germany.
103 of 130 questionnaires were returned and suitable for analysis. The use of heparin (unfractionated and/or low-molecular-weight) is common, with some variation depending on the type of operation (83.5-99%). In spinal procedures, heparin administration is commonly started early, i. e., between the preoperative and first postoperative day (90.3-97.1%). This differs in intracranial procedures. In most neurosurgical departments heparin administration is stopped at the day of discharge (69.6-77.4% depending on procedure). Enoxaparin is the most commonly used heparin. In spinal as well as in cranial procedures, thrombosis risk reduction is unanimously assumed to be lesser the later administration starts. The estimation of the risks related to heparin injection are considered to be higher in cranial than in spinal operation in the early postoperative period. Most departments use antithrombotic stockings (ATS) irrespective of the type of surgery. However, 11% never use ATS.
In spinal surgery, a trend towards homogenization is observed with the early use of heparin. In intracranial procedures, practice is more heterogenous. The heterogeneity is due to the fact that the data available in the literature does not allow for the identification of an optimal protocol.
对于神经外科患者深静脉血栓形成（DVT）最合适的围手术期预防措施尚无共识。本研究的目的是回顾当前的做法并寻找DVT预防的标准方案。
针对4组神经外科手术围手术期DVT的常规预防以及围手术期使用肝素（普通肝素和/或低分子肝素）的风险和益处评估的问卷，被发送至德国的130个神经外科科室。
130份问卷中有103份被退回且适合分析。肝素（普通肝素和/或低分子肝素）的使用很普遍，根据手术类型存在一些差异（83.5 - 99%）。在脊柱手术中，肝素给药通常较早开始，即在术前和术后第一天之间（90.3 - 97.1%）。颅内手术则不同。在大多数神经外科科室，肝素给药在出院当天停止（根据手术类型为69.6 - 77.4%）。依诺肝素是最常用的肝素。在脊柱和颅脑手术中，一致认为肝素给药开始得越晚，血栓形成风险降低得越少。在术后早期，人们认为颅内手术中肝素注射相关风险高于脊柱手术。大多数科室无论手术类型如何都使用抗血栓袜（ATS）。然而，11%的科室从不使用ATS。
在脊柱手术中，观察到早期使用肝素呈现同质化趋势。在颅内手术中，做法更为异质化。这种异质性是由于文献中可用的数据无法确定最佳方案。
