Ting AC, Cheng SW, Cheung GC, Wu LL, Hung KN, Fan YW.
Perioperative deep vein thrombosis in Chinese patients undergoing craniotomy.
Surg Neurol 2002 Sep-Oct;58(3-4):274-8; discussion 278-9

Department of Surgery, University of Hong Kong Medical Centre, Queen Mary
Hospital, Pokfulam, Hong Kong.

BACKGROUND: We attempted to determine the incidence of perioperative deep vein
thrombosis (DVT) in Chinese patients undergoing elective craniotomy for brain
tumors and to assess the efficacy of clinical and serial calf circumference
assessment in detecting DVT. METHODS: Between June 1999 and February 2001, 100
consecutive patients who underwent elective craniotomy for brain tumors at the
Department of Neurosurgery, University of Hong Kong Medical Centre were examined
for perioperative DVT. The demographic data, Glasgow coma score (GCS), mobility
status, and the operative details were recorded. Graduated compression stockings
and intermittent pneumatic compression were applied perioperatively as
prophylaxis against DVT. Serial duplex scans were performed before and after
operation. Clinical examination was also performed daily to look for signs of
DVT. The calf circumference was measured at fixed levels for both limbs before
each duplex scan surveillance. RESULTS: The study group consisted of 44 males and
56 females, with a mean age of 54 +/- 15 years (range, 20-81 years). There was no
preoperative DVT. Postoperative DVT was detected on duplex scan in four patients
(4%), two of whom had bilateral involvement. The thrombosis was confined to the
calf veins in two limbs. The demographic data, neurologic status and operative
details of patients with and without DVT were similar. Patients with DVT had no
clinically recognizable signs. The change in calf circumference measurement was
also not predictive of DVT. CONCLUSIONS: The incidence of perioperative DVT in
Chinese patients undergoing elective craniotomy for brain tumors appears to be
low with the present mechanical prophylactic measures. Given the low incidence of
proximal DVT as detected by duplex scan, the use of heparin prophylaxis may not
be justified because of the increased risk of intracranial bleeding. Clinical
assessment with calf circumference measurement is unreliable in the diagnosis of
DVT.