Safety and Efficacy of Deep Venous Thrombosis Chemoprophylaxis in Neurosurgery Patients.

BACKGROUND AND OBJECTIVE: Deep venous thrombosis (DVT) and pulmonary embolism (PE) remain significant sources of morbidity and mortality in neurosurgical patients. Although chemoprophylaxis has been shown to reduce thromboembolic events, its routine use is controversial due to the potential risk of hemorrhagic complications. This study evaluated the safety and efficacy of DVT chemoprophylaxis compared with no chemoprophylaxis in postoperative neurosurgical patients. METHODS: We conducted a single-center retrospective chart review of adult patients who underwent neurosurgical procedures in 2019 with a hospital stay ≥5 days. The primary outcome was the incidence of symptomatic venous thromboembolism (VTE) within 90 days. Secondary outcomes measured were bleeding, wound complications, and return to the operating room within 30 days. Multivariable logistic regression was performed to assess the association of chemoprophylaxis with outcomes, adjusting for key covariates. Subgroup analysis was conducted to evaluate the effect of prophylaxis timing. RESULTS: A total of 340 patients met the study criteria. Chemoprophylaxis was administered to 176 patients (51.8%). Symptomatic VTE occurred in seven patients (2.06%). Use of chemoprophylaxis was not associated with reduced VTE risk (OR 4.6, p = 0.17). Spinal surgery compared to cranial surgery (OR 13.7, p = 0.03) and prior VTE history (OR 26.0, p = 0.03) were independently associated with higher VTE risk. Bleeding and wound complications were rare (<1%) and were not associated with chemoprophylaxis. Subgroup analysis of patients who received chemoprophylaxis demonstrated that timing of initiation was not significantly associated with VTE rates. CONCLUSION: No statistically significant association was detected between DVT chemoprophylaxis and symptomatic VTE in this cohort. The higher observed VTE rate among patients receiving chemoprophylaxis should not be interpreted as evidence of reduced efficacy or increased VTE risk given the non-randomized design and potential for confounding by indication. The low frequency of bleeding and wound complications is reassuring, but the small number of events limits conclusions regarding safety. Individualized risk stratification may be particularly important for patients undergoing spinal surgery or with prior VTE. Prospective multicenter studies are needed to better define optimal prophylaxis strategies.