Prevention of Venous Thrombosis in Neurosurgical Patients by Intermittent Calf Compression

Abstract

The risk of intracranial haemorrhage precludes the use of anticoagulant prophylaxis for venous thrombosis in neurosurgical patients. We have studied prospectively in this group, the effect of intermittent calf compression by inflatable plastic boots on the prevention of deep vein thrombosis detected by 125 Iodine-labelled fibrinogen leg scanning. Intermittent calf compression was continued for 5 days in the treatment group. In the control and treatment groups, leg scanning was continued until the patients were fully mobile or for a maximum of 14 days. In all patients during prophylaxis, deep vein thrombosis was detected in 12/62 (19.35%) patients in the untreated group and 1/60 (1.67%) patients in the prophylaxis group (P < 0.002). In patients who had craniotomy for brain tumour, subarachnoid haemorrhage, or subdural haeinatoma, leg scan detected deep vein thrombosis occurred during the 5 days of prophylaxis in 9/43 (20.93%) untreated and 0/43 (0%) treated patients (P < 0.002). At 14 days, deep vein thrombosis was detected in 13/43 (30.23%) untreated and 4/43 (9.3%) treated patients (P < 0,05). In η on-operated patients, leg scan detected deep vein thrombosis occurred in 3/19 (15.79%) untreated and in 1/17 (5.88%) treated patients (P = 0.34). The results indicate that intermittent calf compression is effective prophylaxis against leg scan detected deep vein thrombosis in neurosurgical patients. In post-operative patients the difference is highly significant during intermittent calf compression and the difference is maintained after prophylaxis is discontinued. In non-operated patients, although there is a trend, the difference in incidence of deep vein thrombosis between control and treated groups is not significant.