Characteristics of studies included in the review
| Study . | N . | Patient description . | Type of neurosurgery . | Pharmacologic thromboprophylaxis . | Co-interventions . | Route, dose, and time of pharmacologic thromboprophylaxis . | Time to follow-up . | DVT diagnostic technique . | Outcomes assessed . |
|---|---|---|---|---|---|---|---|---|---|
| RCT | |||||||||
| Agnelli et al20 | 307* | Age 18 y or older | Elective cranial or spinal surgery | LMWH (enoxaparin) | Thigh-length TED CS in all patients | Subcutaneous injections, 40 mg per day for 8 ± 1 d | 60 d | Ultrasonography and venography in case of positive ultrasonography | M, PE, DVT†, MB |
| Cerrato et al3 | 100* | Age 40 y or older | Elective neurosurgical procedures | UFH | None reported | Subcutaneous injections, 5000 IU every 8 h for at least 7 d | Not reported | 125I-labeled fibrinogen | DVT‡ |
| Constantini et al21 | 103* | Age 40 y or older | Craniotomy for brain tumor removal | UFH | None reported | Subcutaneous injections, 5000 IU every 12 h for 7 d or until full ambulation | Not reported | Not reported§ | M, DVT||, MB, RO |
| Dickinson et al22 ¶ | 66* | Age 18 y or older with a diagnosis of an intracranial neoplasm | Craniotomy or stereotactic biopsy | LMWH (enoxaparin) | Thigh-high TED CS in all patients only before random assignment | Subcutaneous injections, 30 mg every 12 h until hospital discharge from neurosurgery service | Not reported | Duplex ultrasonography | M, DVT#, MB |
| Gruber et al23 | 50* | Adults undergoing lumbar disc operations | Herniated lumbar disc operations | Heparin-DHE | None reported | Subcutaneous injections, 2500 IU; 0.5 mg every 12 h for at least 7 d or until hospital discharge | Not reported | Phlebogram, plethysmography, Doppler ultrasound, or an 125I fibrinogen test | PE, DVT||, MB |
| Halim et al30 | 74* | Adult with ASCI | Anterior and/or posterior surgical approach | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day for 8 wk | 2 weeks | Color Doppler venous ultrasonography | DVT** |
| Hamidi and Riazi24 | 89* | Age 18 to 75 y | Elective instrumental spinal surgery | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day within 12 h before surgery | 2 wk and 8 mo after surgery | Compression Doppler ultrasonography | M, DVT**, MB, RO |
| Nurmohamed et al25 | 485* | Age 18 y or older | Craniotomy or spinal column surgery for a tumor or injury | LMWH (nadroparin calcium) | TED CS in all patients | Subcutaneous injections, 7500 IU anti-factor Xa per day for 10 d or until hospital discharge | 56 d after surgery | B-mode compression ultrasonography and venogram in case of positive ultrasonography | M, proximal DVT††, MB |
| Rokito et al26 ¶ | 110* | Age 18 y or older | Major reconstructive spinal surgery | Warfarin (coumadin) | Thigh-high TED CS in all patients | 10 mg before surgery; doses were adjusted accordingly to prothrombin time | 1 y | Duplex ultrasonography and venography in case of positive ultrasonography | PE, DVT**, MB |
| Sonaglia et al31 | 157* | Age 18 y or older | Neurosurgery for brain or spinal tumor | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day for not less than 7 d | Not reported | Venography | Proximal and distal DVT# |
| NRS | |||||||||
| Bauman et al27 | 254 | Had movement disorders (Parkinson disease, essential tremor, dystonia) | Deep brain stimulation surgery | UFH | CS in all patients and pneumatic, compression boots postoperatively | Subcutaneous injections, 50 mg before surgery and 50 mg every 12 h after surgery. Duration of pharmacologic thromboprophylaxis not reported | Not reported | Doppler ultrasonography | M, DVT||, PE, MB |
| Dermody et al28 | 174 | Neurosurgical patients, who underwent screening with once-per-week VDUS of the bilateral lower extremities | Endovascular coiling or clipping, craniotomy, stereotactic, biopsy, spine surgery, trans sphenoidal surgery | UFH or LMWH (enoxaparin) | Mechanical prophylaxis | UFH: 5000 IU, 2 or 3 times per day; enoxaparin, not reported | 6 mo | Venous duplex ultrasound | MB, DVT‡‡ |
| Hacker et al29 | 522 | Neurosurgical postoperative patients admitted to SICU | Cervical spinal cord, decompression, cervical laminectomy, craniotomy/craniectomy, decompressive laminectomy, nasal sinuses surgery | UFH | Lower extremity compression boots | Subcutaneous injections, 5000 IU every 8 h until hospital discharge | Until death or until discharged from the hospital | Ultrasound evaluation | M, DVTa, PE, MB |
| Khaldi et al32 | 2638 | Underwent a neurosurgical procedure | Multilevel lumbar surgeries, major spine surgery, head surgery | UFH | Mechanical DVT prophylaxis | Subcutaneous injections, 5000 IU every 12 h | Not reported | Duplex ultrasonography | PE, DVTa, MBb |
| Zachariah et al33 | 241 | Had subarachnoid hemorrhage and external ventricular drain | None reported | UFH, LMWH, or warfarin | Sequential compression devices | Not reported | Not reported | Venous ultrasound | DVT‡‡ |
| Study . | N . | Patient description . | Type of neurosurgery . | Pharmacologic thromboprophylaxis . | Co-interventions . | Route, dose, and time of pharmacologic thromboprophylaxis . | Time to follow-up . | DVT diagnostic technique . | Outcomes assessed . |
|---|---|---|---|---|---|---|---|---|---|
| RCT | |||||||||
| Agnelli et al20 | 307* | Age 18 y or older | Elective cranial or spinal surgery | LMWH (enoxaparin) | Thigh-length TED CS in all patients | Subcutaneous injections, 40 mg per day for 8 ± 1 d | 60 d | Ultrasonography and venography in case of positive ultrasonography | M, PE, DVT†, MB |
| Cerrato et al3 | 100* | Age 40 y or older | Elective neurosurgical procedures | UFH | None reported | Subcutaneous injections, 5000 IU every 8 h for at least 7 d | Not reported | 125I-labeled fibrinogen | DVT‡ |
| Constantini et al21 | 103* | Age 40 y or older | Craniotomy for brain tumor removal | UFH | None reported | Subcutaneous injections, 5000 IU every 12 h for 7 d or until full ambulation | Not reported | Not reported§ | M, DVT||, MB, RO |
| Dickinson et al22 ¶ | 66* | Age 18 y or older with a diagnosis of an intracranial neoplasm | Craniotomy or stereotactic biopsy | LMWH (enoxaparin) | Thigh-high TED CS in all patients only before random assignment | Subcutaneous injections, 30 mg every 12 h until hospital discharge from neurosurgery service | Not reported | Duplex ultrasonography | M, DVT#, MB |
| Gruber et al23 | 50* | Adults undergoing lumbar disc operations | Herniated lumbar disc operations | Heparin-DHE | None reported | Subcutaneous injections, 2500 IU; 0.5 mg every 12 h for at least 7 d or until hospital discharge | Not reported | Phlebogram, plethysmography, Doppler ultrasound, or an 125I fibrinogen test | PE, DVT||, MB |
| Halim et al30 | 74* | Adult with ASCI | Anterior and/or posterior surgical approach | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day for 8 wk | 2 weeks | Color Doppler venous ultrasonography | DVT** |
| Hamidi and Riazi24 | 89* | Age 18 to 75 y | Elective instrumental spinal surgery | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day within 12 h before surgery | 2 wk and 8 mo after surgery | Compression Doppler ultrasonography | M, DVT**, MB, RO |
| Nurmohamed et al25 | 485* | Age 18 y or older | Craniotomy or spinal column surgery for a tumor or injury | LMWH (nadroparin calcium) | TED CS in all patients | Subcutaneous injections, 7500 IU anti-factor Xa per day for 10 d or until hospital discharge | 56 d after surgery | B-mode compression ultrasonography and venogram in case of positive ultrasonography | M, proximal DVT††, MB |
| Rokito et al26 ¶ | 110* | Age 18 y or older | Major reconstructive spinal surgery | Warfarin (coumadin) | Thigh-high TED CS in all patients | 10 mg before surgery; doses were adjusted accordingly to prothrombin time | 1 y | Duplex ultrasonography and venography in case of positive ultrasonography | PE, DVT**, MB |
| Sonaglia et al31 | 157* | Age 18 y or older | Neurosurgery for brain or spinal tumor | LMWH (enoxaparin) | CS in all patients | Subcutaneous injections, 40 mg per day for not less than 7 d | Not reported | Venography | Proximal and distal DVT# |
| NRS | |||||||||
| Bauman et al27 | 254 | Had movement disorders (Parkinson disease, essential tremor, dystonia) | Deep brain stimulation surgery | UFH | CS in all patients and pneumatic, compression boots postoperatively | Subcutaneous injections, 50 mg before surgery and 50 mg every 12 h after surgery. Duration of pharmacologic thromboprophylaxis not reported | Not reported | Doppler ultrasonography | M, DVT||, PE, MB |
| Dermody et al28 | 174 | Neurosurgical patients, who underwent screening with once-per-week VDUS of the bilateral lower extremities | Endovascular coiling or clipping, craniotomy, stereotactic, biopsy, spine surgery, trans sphenoidal surgery | UFH or LMWH (enoxaparin) | Mechanical prophylaxis | UFH: 5000 IU, 2 or 3 times per day; enoxaparin, not reported | 6 mo | Venous duplex ultrasound | MB, DVT‡‡ |
| Hacker et al29 | 522 | Neurosurgical postoperative patients admitted to SICU | Cervical spinal cord, decompression, cervical laminectomy, craniotomy/craniectomy, decompressive laminectomy, nasal sinuses surgery | UFH | Lower extremity compression boots | Subcutaneous injections, 5000 IU every 8 h until hospital discharge | Until death or until discharged from the hospital | Ultrasound evaluation | M, DVTa, PE, MB |
| Khaldi et al32 | 2638 | Underwent a neurosurgical procedure | Multilevel lumbar surgeries, major spine surgery, head surgery | UFH | Mechanical DVT prophylaxis | Subcutaneous injections, 5000 IU every 12 h | Not reported | Duplex ultrasonography | PE, DVTa, MBb |
| Zachariah et al33 | 241 | Had subarachnoid hemorrhage and external ventricular drain | None reported | UFH, LMWH, or warfarin | Sequential compression devices | Not reported | Not reported | Venous ultrasound | DVT‡‡ |
ASCI, acute spinal cord injury; DHE, dihydroergotamine; M, mortality; MB, major bleeding; RO, reoperation; SICU, surgical intensive care unit; TED, thrombosis embolic deterrent; VDUS, venous duplex ultrasound.
Number of patients randomly assigned.
Symptomatic proximal DVT, screening-detected proximal DVT, screening-detected distal DVT, symptomatic proximal and distal DVT (any symptomatic DVT).
Asymptomatic DVT, but authors did not make distinction in proximal or distal DVT.
Authors reported DVT only by clinical evidence.
Symptomatic proximal and distal DVT (any symptomatic DVT).
Three-arm RCT.
Screening-detected proximal and distal DVT (any asymptomatic DVT).
Symptomatic proximal and distal DVT (any symptomatic DVT), screening-detected proximal and distal DVT (any asymptomatic DVT).
Screening-detected proximal DVT, symptomatic proximal and distal DVT (any symptomatic DVT), screening-detected proximal and distal DVT (any asymptomatic DVT).
No distinction between proximal, distal, symptomatic, or asymptomatic DVT.
DVT events were not reported.
Findings were reported qualitatively.