Frim DM, Barker FG 2nd, Poletti CE, Hamilton AJ.
Postoperative low-dose heparin decreases thromboembolic complications in
neurosurgical patients.
Neurosurgery 1992 Jun;30(6):830-2; discussion 832-3

Neurosurgery Service, Massachusetts General Hospital, Harvard Medical School, Boston.

Thromboembolic complications are a major cause of postoperative morbidity and
mortality in the neurosurgical patient. Prophylaxis with lower extremity
pneumatic compression boots (PCBs) reduces the incidence of lower extremity deep
vein thrombosis (DVT) but has not been shown to affect the incidence of pulmonary
embolism (PE). Prophylaxis with low-dose heparin has consistently reduced the
incidence of both DVT and PE in studies on general surgical patients but has not
been adopted for use in neurosurgery primarily for fear of causing catastrophic
hemorrhage. We report on a series of 138 consecutive adult patients who underwent
major neurosurgical procedures on a general neurosurgical service at our
institution. Patients were treated with intraoperative PCBs and, starting on the
morning of the first postoperative day, with a regimen of 5000 U of heparin
administered subcutaneously twice daily. This treatment was continued until
patients were fully ambulatory. PCBs were discontinued 24 hours after the first
administration of heparin. None of the heparin-treated patients suffered
postoperative hemorrhage. We compared this series with a control group of 473
adult patients who had previously undergone major neurosurgical procedures on the
same neurosurgical service. These patients had been treated with intraoperative
and postoperative PCBs alone. The control group had a 3.2% incidence of
thromboembolic complications (15 of 473; eight DVT, seven PE). Prophylaxis with
PCBs plus heparin significantly (P = 0.020) reduced the incidence of
thromboembolic complications: no PCBs/heparin-treated patient exhibited clinical
evidence of PE or DVT (0%, 0/138). We conclude that a combination of
intraoperative PCBs and postoperative low-dose heparin is a safe and effective
method by which to reduce thromboembolic complications in the neurosurgical
patient.