Macdonald RL, Amidei C, Baron J, Weir B, Brown F, Erickson RK, Hekmatpanah J, Frim D.
Randomized, pilot study of intermittent pneumatic compression
devices plus dalteparin versus intermittent pneumatic compression
devices plus heparin for prevention of venous thromboembolism
in patients undergoing craniotomy.
Surg Neurol. 2003 May;59(5):363-72; discussion 372-4.

Department of Surgery, Section of Neurosurgery, Pritzker School of
Medicine, University of Chicago Medical Center, Chicago,
Illinois, USA.
BACKGROUND: Unfractionated heparin and the low molecular
weight heparin, dalteparin, are used for prophylaxis against
venous thromboembolism in patients undergoing craniotomy.
These drugs were compared in a randomized, prospective pilot
study comparing intermittent pneumatic compression devices plus
dalteparin to intermittent pneumatic compression devices plus
heparin. METHODS: One hundred patients undergoing
craniotomy were randomly allocated to receive perioperative
prophylaxis with subcutaneous (SC heparin, 5000 units every 12
hours, or dalteparin, 2,500 units once a day, begun at induction of anesthesia and continued for 7 days or until the patient was
ambulating. Entry criteria were age over 18 years, no deep vein
thrombosis (DVT) preoperatively as judged by lower limb duplex
ultrasound and no clinical evidence of pulmonary embolism
preoperatively. Patients with hypersensitivity to heparin,
penetrating head injury or who refused informed consent were
excluded. Patients underwent a duplex study 1 week after surgery
and 1 month clinical follow-up. All patients were treated with
lower limb intermittent pneumatic compression devices.
RESULTS: There were no differences between groups in age,
gender, and risk factors for venous thromboembolism. There were
no differences between groups in intraoperative blood loss,
transfusion requirements or postoperative platelet counts. Two
patients receiving dalteparin developed DVT (one symptomatic
and one asymptomatic). No patient treated with heparin developed
DVT and no patient in either group developed pulmonary
embolism. There were two hemorrhages that did not require repeat
craniotomy in patients receiving dalteparin and one that did
require surgical evacuation in a patient treated with heparin. Drug was stopped in two patients treated with dalteparin because of thrombocytopenia. None of these differences were statistically
significant. CONCLUSION: There was no significant difference
in postoperative hemorrhage, venous thromboembolism or
thrombocytopenia between heparin and dalteparin. The results
suggest that, given the small sample size of this trial, both drugs
appear to be safe and the incidence of venous thromboembolism
by postoperative screening duplex ultrasound appears to be low
when these agents are used in combination with intermittent
pneumatic compression devices.