Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), and intracranial hemorrhage (ICH) may complicate the post-operative course of patients undergoing craniotomy. While prophylaxis with unfractionated heparin (UFH) has been shown to reduce VTE rates, twice-daily (BID) and three-times-daily (TID) UFH dosing regimens have not been compared in neurosurgical procedures. The objective of this study was to explore the association between UFH dosing regimen and rates of VTE and ICH in craniotomy patients.
A retrospective chart review was conducted for 159 patients at [BLINDED FOR REVIEW] receiving 5000units/0.5mL UFH injections either BID (n=132) or TID (n=27). General linear regression models were run to predict rates of DVT, PE, and reoperation due to bleeding from UFH dosing regimen while controlling for age at surgery, sex, VTE history, craniotomy for tumor resection, surgery duration, length of stay, reoperation, infections, and IDH/MGMT mutations.
Receiving UFH TID was significantly associated with a lower rate of PE when compared to receiving UFH BID (β = -0.121, p=0.044; TID rate = 0%, BID rate = 10.6%). UFH TID also showed a trend toward lower rates of DVT (β = -0.0893, p=0.295; TID rate = 18.5%, BID rate = 21.2%) when compared to UFH BID. UFH TID showed no significant difference in rate of reoperation for bleeding when compared to UFH BID (β = -0.00623, p=0.725; TID rate = 0%, BID rate = 0.8%).
UFH TID dosing is associated with lower rates of PE when compared to BID dosing in patients undergoing craniotomy.

Copyright © 2021. Published by Elsevier Inc.