Deep Vein Thrombosis and the Neurosurgical Patient
10.21315/mjms2019.26.5.13
- Author:
Rakesh Rethinasamy
1
;
Azmi Alias
1
;
Regunath Kandasamy
2
;
Azman Raffiq
1
;
Mun Choon Looi
1
;
Tassha Hillda
1
Author Information
1. Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
2. School of Medical Sciences, Hospital Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
- Publication Type:Journal Article
- Keywords:
Keywords;
deep vein thrombosis, trauma, brain tumour, Well’s score, D-dimer
- From:Malaysian Journal of Medical Sciences
2019;26(5):139-147
- CountryMalaysia
- Language:English
-
Abstract:
Background: Neurosurgical patients are varied, encompassing cranial and spinal
diseases and trauma, and are admitted under both elective and emergency settings. In all settings,
neurosurgery patients are at risk of deep vein thrombosis. D-dimer and ultrasound Doppler have
long been good screening and confirmatory tools for the diagnosis of deep vein thrombosis (DVT).
We conducted a study to identify the factors associated with DVT among neurosurgical patients,
and the overall rate of occurrence at our centre. We aimed to also compare our results to the
incidence in similar studies elsewhere in which more judicious use of pharmacological prophylaxis
was undertaken. We also included the Well’s score to validate its usefulness in screening for DVT
in our local setting.
Methods: All patients admitted into our centre were screened for eligibility and those
who underwent surgery from September 2016 to September 2017 had a D-dimer screening after
surgery, followed by an ultrasound Doppler if the former was positive. The choice of anticoagulant
therapy was not influenced by this study, and observation of the use was in keeping with usual
practices in our centre was done.
Results: A total number of 331 patients were recruited in this study, however, after the
inclusion and exclusion criteria had been met, 320 patients remained eligible, i.e. suitable for
analysis. The mean age of our patients was 46 years, with 66% being male patients. A majority of
the cases in this study were cranial related, with only 5% being spine surgeries. On the multivariate
analysis, the Well’s score and the number of days in bed remained statistically significant,
after adjusting for age group, gender, ethnicity, type of central venous access and type of DVT
prophylaxis with an adjusted odd’s ratio, and a confidence interval of 95%, and P < 0.05 for each.
Conclusion: Well’s scoring and number of days in bed were independent factors affecting
the rate of DVT in patients undergoing neurosurgical procedures in our centre.
- Full text:3.2019my0819.pdf
