ARRS 2022 Abstracts

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ERS3338. Is It Worth It? Institutional Experience in DVT Screening of Neurosurgery Patients with Contraindication to Anticoagulation
Authors * Denotes Presenting Author
  1. Ece Meram *; University of Wisconsin-Madison
  2. Lori Mankowski Gettle; University of Wisconsin-Madison
Objective:
There has been a recent trend towards asymptomatic screening for deep venous thrombosis (DVT) in patients who underwent neurosurgical procedures and cannot be anticoagulated including prophylactic subcutaneous heparin due to risk of bleeding. This study aimed to evaluate the institutional incidence rate of DVT in this patient population to investigate the value and benefit of this practice.

Materials and Methods:
From October 4, 2019 to October 10, 2020, the US doppler extremity studies for DVT analysis were collected and only studies ordered by neurosurgery providers were included in the study. The indication for studies usually included phrases such as “craniotomy” or “DVT screening”. Any study that included a symptom in the indication or repeat DVT studies for re-evaluation of a known clot were excluded from the analysis. Descriptive statistics were used for analysis.

Results:
Out of 318 studies, a total of 281 studies (181 patients) were included in the analysis while 37 studies were excluded for the presence of symptoms, chronic thrombi, or follow-up studies for known acute thrombi. Of 181 patients, 63 underwent multiple studies (median 3, range: 2-6). The incidence of DVT was 3.5% (10 of 281) and superficial venous thrombosis was 2.4 % (7 of 281) with 3 patients having both. Of 10 patients with DVTs, 4 had thrombus involving the veins above the knee including the popliteal vein and only 3 studies were positive bilaterally. Furthermore, 3 of the 10 patients had an upper extremity DVT, two of which were associated with peripherally inserted central catheters. The approximate cost of a Doppler extremity ultrasound at our institution is 1935$ with an uninsured patient paying 1256$.

Conclusion:
While hospitalized patients who underwent neurosurgery with contraindication to anticoagulation may have a potential risk of developing a DVT, this study demonstrated a low incidence of asymptomatic DVTs in our institution, most of which were non-actionable. Given the time dedicated to a DVT study by the patient and sonographer as well as the cost associated with it, one cannot but wonder whether DVT screening in asymptomatic neurosurgical patients is really worth it.