Prophylactic long-term anticoagulant treatment of hydrocephalic patients with ventriculo-atrial shunts.

Thrombosis of the superior vena cava is a frequent cause of death among patients with ventriculo-atrial shunts. In this study, one group of spina-bifida children with such shunts was treated with prophylactic anticoagulant therapy and a second group was not. While there was no significant difference between the two groups in the number of shunt revisions required over a six-year period, distal catheter complications were twice as frequent in the group not receiving anticoagulant therapy. There was little difference between the groups in the rate of proximal catheter revisions. It is suggested that the benefit of anticoagulant therapy is in transferring shunt problems from the distal to the proximal catheter, obstruction of which is less dangerous and more easily treated.