AANS Beyond 2021: Full Collection-New Innovations in VTE Chemoprophylaxis

Video Transcription

Video Summary

The transcript of the video discusses the latest research on venous thromboembolism (VTE) chemoprophylaxis in neurosurgical patients. The speaker provides an overview of various studies evaluating different methods of chemoprophylaxis, including the use of low molecular weight heparin and unfractionated heparin. The speaker highlights the concerns and benefits of each medication and presents findings from several retrospective studies. <br /><br />One study compared low molecular weight heparin and unfractionated heparin in traumatic brain injury patients and found that low molecular weight heparin was associated with more intracranial hemorrhage progression. Another study evaluated the timing of chemoprophylaxis initiation in traumatic intracranial hemorrhage patients and found no significant difference in hemorrhage expansion based on early or late initiation. <br /><br />In the study of patients with severe traumatic brain injury, it was found that delayed prophylaxis and the use of unfractionated heparin were risk factors for increased VTE and mortality. The timing of prophylaxis initiation in spinal trauma patients also showed no difference in hemorrhage expansion. <br /><br />The video also discusses the dosing of low molecular weight heparin, with some studies suggesting that weight-based dosing may be more appropriate to achieve therapeutic levels. Additionally, the importance of accurate VTE risk assessments and proper processes of care in initiating and maintaining chemoprophylaxis are emphasized. <br /><br />In a study of patients with subarachnoid hemorrhage, continuous heparin infusion was compared to standard prophylactic subcutaneous heparin. The study showed that the heparin infusion group had a lower rate of cerebral infarction and DVT compared to the standard prophylaxis group, without an increased risk of re-bleeding. <br /><br />Overall, while there is no definitive evidence on the superiority of one medication or timing over another, the video suggests that initiating low molecular weight heparin within 24 hours of the event or surgery, pending a stable head CT, may be beneficial for neurosurgical patients.

Keywords

venous thromboembolism

chemoprophylaxis

neurosurgical patients

low molecular weight heparin

unfractionated heparin

intracranial hemorrhage

retrospective studies