Introduction: Thrombo-embolic events (TEE), including deep venous thrombosis (DVT) and pulmonary embolus (PE), are worrisome complications following a craniotomy. The use of anticoagulants to prevent or treat TEE might put the patients at an increased risk of intracranial hemorrhage after surgery. The neurosurgeon must weigh the benefits of anticoagulants against the risks of intracranial hemorrhage. Data is still lacking to offer a safe line of conduct.
Methods: A retrospective review of the charts of all craniotomies performed between 2006 and 2012 in a single institution was done. The charts were screened for the occurrence and risk factors of TEE, the use of prophylactic or therapeutic anticoagulation and the occurrence of intracranial post-operative hemorrhage.
Results: 2010 craniotomies were performed on 1448 patients. The overall incidence of TEE was 1,6%. The use of prophylactic heparin reduced the risk of TEE by a 2,3 factor (p = 0,027). Prophylactic heparin did not increased the risk for a post-operative intracranial hemorrhage. In the subgroup of patients initially operated for an intracranial hemorrhage, prophylactic heparin also did not statistically augment the risk of post-operative bleeding (p = 0,7). When combined with prophylactic heparin, early post-operative mobilisation further significantly reduced the risks of TEE (OR: 2,98 p = 0,01).
Conclusions: Prophylactic heparin after a craniotomy significantly reduced the risk of TEE while not augmenting the risk of post-operative intracranial hemorrhage. In our series, early mobilisation amplified the benefit of prophylactic heparin.
Patient Care: It gives new data regarding the prevention of thrombo-embolic events following a craniotomy. It also gives new data on the safety of anticoagulants following a craniotomy. These informations will help improve post-operative care in regard of the prevention of thrombo-embolic events and intracranial hemorrhage.
Learning Objectives: By the conclusion of this session, participants will be able to: 1) Identify the main risk factors for thrombo-embolic events following a craniotomy 2) discuss of the importance of thromboprophylaxy and early mobilisation after a craniotomy and 3) discuss of the safety of prophylaxic and therapeutic anticoagulation after a craniotomy