Prospective, randomized trial of temporary inferior vena cava filter in thrombophilic patients that had cranial or spinal surgery. No conflict of interest. Thrombophilic patients on anticoagulation for symptomatic deep vein thrombosis or pulmonary embolism do develop neurosurgical problems that require cranial or spine surgery. There is little, if any, literature on thrombophilic patients undergoing neurosurgery. A paper on thrombophilic patients undergoing orthopedic hip or knee surgery documented a five-fold increase in symptomatic postoperative venous thromboembolism. A report documented a 67% rate of bleeding complications in patients who developed a pulmonary embolism requiring anticoagulation after spinal fusion. A report on using a permanent inferior vena cava filter in high-risk spine surgery patients eliminated the risk of pulmonary embolism, but the filter caused a 5% risk of symptomatic deep vein thrombosis. Our hypothesis, patients with a known thrombophilia and multiple deep vein thromboses and or pulmonary embolisms on anticoagulation that need neurosurgery will have significantly fewer thrombotic or hemorrhagic complications with a temporary inferior vena cava filter placed as compared to patients that did not have a filter placed. Our trial design was prospective randomized one-to-one randomization of known thrombophilic patients who needed elective spinal and cranial neurosurgery. Group 1 temporary IVC filter group had filter placed one week before elective surgery and anticoagulation stopped. Two weeks after surgery, when wound healed, anticoagulation was resumed and the IVC filter removed. Group 2, the known filter group, had anticoagulation stopped before surgery and then the anticoagulation was resumed three to seven days after surgery. Hemorrhagic and hemorrhagic complications were assessed along with mortality by both chi-square and logistic regression multivariate statistical analysis. Patient demographics, group 1, IVC filter group, N equals 93. Group 2, no IVC filter group, N equals 94. The age ranges were 19 to 83 with a mean of 61 years in group 1 and almost identical in group 2. Sex distribution in group 1, 57% female, 43% male, almost identical in group 2. of thrombophilias, 30% factor V Leiden, morbid obesity, 18%, antiphospholipid antibody, 18%, cancer, 10%, prothrombin mutation, 8%, protein C deficiency, 5%, protein S deficiency, 5%, peripartum, 4%, sickle cell anemia, 1%, and the distribution in the group 2 is almost identical to group 1. Cranial surgery was 17% and 83% spinal surgery, again, almost identical in group 2. And length of surgery was almost identical for both groups. In the group 1 IVC filter group, no pulmonary embolisms, no sudden deaths, no hemorrhagic complications, 22% had thrombus in the filter at removal, one non-operative leg hematoma at filter removal. In the group 2, no IVC filter group, 15% pulmonary embolism rate, 7% sudden death from saddle pulmonary embolism, 9% hemorrhagic complications requiring reoperation. High square statistical analysis, there were less pulmonary embolisms in the IVC filter the P less than 0.001, less sudden death in IVC filter group with the P equal to 0.01, and less hemorrhagic complications in the IVC filter group with the P less than 0.01. Regression multivariate analysis, only the temporary IVC filter lessened complications with a P value of less than 0.01. Sex, length of surgery, type of surgery, or type of thrombophilia were statistically insignificant. Conclusion, the use of a temporary IVC filter in thrombophilic patients that need elective cranial or spinal surgery is safe and statistically significantly lessens pulmonary embolisms, sudden death from saddle pulmonary embolism, and hemorrhagic complications due to early re-anticoagulation. This is a very easy strategy to implement in this high-risk group, and I strongly recommend you all adopt this approach. Thank you.

prospective randomized trial

thrombophilic patients

cranial or spinal surgery

temporary inferior vena cava filter

thrombotic or hemorrhagic complications