SHORT-TERM OUTCOME OF SURAL VENOUS THROMB OSIS IN NEUROSURGICAL INTENSIVE-CARE PATIENTS WHEN ANTICOAGULANTS ARE CONTRAINDICATED

Venous thrombo-embolic disease in neurosurgical and surgical intensive care units is a frequent disorder (between 4.3 and 43 per cent of pat ients according to studies). The treatment is often difficult. We carr ied out a retrospective study from January 1994 to September 1995 of 5 7 patients in neurosurgical and surgical intensive care who developed thrombosis of a sural vein and in whom anticoagulant at therapeutic do ses was contraindicated. After a median follow up 14 days echography s howed proximal extension of the thrombosis in 4 patients and distal ex tension in 3 others. Five cases of pulmonary embolism occurred during the follow up period, one of which led to death. Na complications (pul monary embolism or proximal extension of venous thrombosis) occurred i n those patients receiving heparin at prophylactic doses (0/11 versus 8/46 in the non-heparin group; p = 0.13). No case of pulmonary embolus occurred in those patients with partial or complete regression of the thrombism (0/21 versus 5/36 in the group with stable or extending thr ombi, p = 0,05). Echographic monitoring enabled therapeutic modificati on in 5 cases. These results indicate that sural venous thrombosis in the context of neurosurgical and surgical intensive care is a potentia lly grave situation and that the prescription of anticoagulant therapy even at preventive dose should always be considered. Further, we prop ose regular echographic monitoring until the patient is mobile.