• Joseph S Bell, T J Florence, H Westley Phillips, Kunal Patel, Nicholas J Macaluso, Paulina G Villanueva, Priyanka K Naik, and Won Kim.
• Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA.
• Neurosurgery. 2021 Aug 16; 89 (3): 527-536.

BackgroundVenous thromboembolism (VTE) represents a rare but preventable postoperative complication. Unfractionated heparin (UH) and low-molecular-weight heparin (LMWH) are used to prevent VTE, but comparative studies of their safety and efficacy in the neurosurgical context are limited.ObjectiveTo determine the relative safety and efficacy of UH and LMWH for prophylaxis after cranial surgery.MethodsWe performed a retrospective analysis of 3204 elective intracranial surgical admissions in 2901 patients over the period 2013 to 2018. From chart review, we extracted demographic and clinical features, including diagnosis and procedure, drugs administered, and the occurrence of VTE events. To compare postoperative outcomes, we performed propensity score matching of patients receiving different drugs, and reviewed postoperative cranial imaging. To contextualize our results, we selected 14 prior neurosurgical studies of VTE prophylaxis to compare our outcomes to the existing literature.ResultsIn our sample of 3204 admissions, the overall rate of VTE was 0.8% (n = 27). Rates of VTE were not statistically different in matched cohorts receiving UH and LMWH (1.7% vs 1.0%, respectively); however, LMWH was associated with a higher rate of clinically significant intracranial hemorrhage (ICH) (3.4% vs 0.5%, P = .008). Literature review and meta-analysis supported these findings. Across studies, UH and LMWH were associated with similar rates of VTE. Studies in which patients received LMWH reported significantly higher rates of ICH (4.9% higher, P = .005).ConclusionWe find that LMWH and UH show similar efficacy in preventing VTE; however, LMWH is associated with higher rates of ICH.© Congress of Neurological Surgeons 2021.

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