VENOUS THROMBOEMBOLISM IN NEUROSURGERY AND NEUROLOGY PATIENTS - A REVIEW

THROMBOEMBOLISM IS A common problem in neurosurgery and neurology pati ents. Within this diverse population are subpopulations of patients wi th varying degrees of thromboembolic risk: low, moderate, and high. Pa tients at substantial risk for deep vein thrombosis and pulmonary embo lism include those with spinal cord injury, brain tumor, subarachnoid hemorrhage, head trauma, stroke, and patients undergoing a neurosurgic al operation. There are prophylactic strategies that can be applied to these various risk groups that will dramatically reduce the incidence of thromboembolism. The risk of pulmonary embolism or fatal pulmonary embolism typically exceeds the risk of severe or fatal bleeding from adequate prophylaxis, and these techniques should be applied on a rout ine basis. To adequately care for patients with deep venous thrombosis and pulmonary embolism, the physician requires a thorough understandi ng of the methods of diagnosis, the pharmacokinetics of heparin and wa rfarin, and a knowledge of their role in the treatment strategies that have proven efficacy and safety. In addition, an awareness of the low molecular weight heparins and heparinoids is becoming essential. Thes e new agents have a potentially promising role in both the prophylaxis and treatment of patients with neurological disease. The principles c oncerning the prophylaxis, diagnosis, and clinical management of venou s thromboembolic disease in neurosurgery and neurology patients are de alt with in this review.