Harvard Medical School, Harvard University, Boston, MA, USA.
Nuffield Department of Clinical Neuroscience, Oxford University Hospitals, UK.
J Clin Neurosci. 2017 Nov;45:60-66. doi: 10.1016/j.jocn.2017.08.008. Epub 2017 Sep 7.
To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world.
Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978).
80 abstracts were reviewed, and 74 articles were extracted.
The majority of DVT seems to develop within the first week after a neurosurgical procedure, and a linear correlation between the duration of surgery and DVT occurrence has been highlighted. The incidence of DVT seems greater for cranial (7.7%) than spinal procedures (1.5%). Although intermittent pneumatic compression (IPC) devices provided adequate reduction of DVT/PE in some cranial and combined cranial/spinal series, low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) further reduced the incidence, not always of DVT, but of PE. Nevertheless, low-dose heparin-based prophylaxis in cranial and spinal series risks minor and major postoperative haemorrhages: 2-4% in cranial series, 3.4% minor and 3.4% major haemorrhages in combined cranial/spinal series, and a 0.7% incidence of major/minor haemorrhages in spinal series.
This analysis showed that currently most of the articles are represented by case series and case reports. As long as clear guidelines will not be defined and universally applied to this diverse group of patients, any prophylaxis for DVT and PE should be tailored to the individual patient with cautious assessment of benefits versus risks.
分析讨论目前全球神经外科部门使用的一些深静脉血栓形成（DVT）/肺栓塞（PE）预防方案。
对英文文献中预防方案进行分析：通过对PubMed 进行搜索（回溯至 1978 年），对神经外科 DVT 预防方案的文献进行了分析和叙述性综述。
共分析了 80 篇摘要，提取了 74 篇文章。
大多数 DVT 似乎在神经外科手术后的第一周内发生，并且手术持续时间与 DVT 发生之间存在线性相关性。与脊柱手术（1.5%）相比，颅神经手术（7.7%）中 DVT 的发生率更高。尽管间歇性气动压迫（IPC）设备在某些颅神经和联合颅/脊柱系列中提供了足够的 DVT/PE 减少，但低剂量皮下未分级肝素（UFH）或低分子肝素（LMWH）进一步降低了 DVT 的发生率，而不是 PE。然而，颅神经和脊柱系列中低剂量肝素预防会导致轻微和严重的术后出血：颅神经系列中为 2-4%，联合颅/脊柱系列中为轻微出血 3.4%和严重出血 3.4%，脊柱系列中严重/轻微出血的发生率为 0.7%。
本分析表明，目前大多数文章都是以病例系列和病例报告的形式呈现的。只要没有明确的指南并普遍适用于这一多样化的患者群体，任何 DVT 和 PE 的预防措施都应根据个体患者量身定制，并谨慎评估收益与风险。
