From the Guidelines
Hydrocephalus and VP shunt procedure are not absolute contraindications to giving VTE prophylaxis, but they require careful consideration, as evidenced by the lack of specific mention in the guidelines 1. The decision to start VTE prophylaxis in patients with hydrocephalus and VP shunt should be individualized, taking into account the patient's specific bleeding risk versus thrombosis risk. Some key factors to consider include:
- The patient's mobility status
- Age
- History of previous VTE
- Presence of other risk factors for thrombosis Pharmacological VTE prophylaxis, such as low molecular weight heparin (e.g., enoxaparin 40mg subcutaneously daily) or unfractionated heparin (e.g., 5000 units subcutaneously every 8-12 hours), can generally be started 24-48 hours after neurosurgical procedures, including VP shunt placement, once hemostasis is assured, as suggested by the guidelines for patients undergoing major surgical intervention 1. For patients with active intracranial bleeding or those at very high bleeding risk, mechanical prophylaxis with sequential compression devices should be used initially, in line with the recommendation for patients who have contraindications to pharmacologic thromboprophylaxis 1. Regular neurological assessments should be performed while on pharmacological prophylaxis to monitor for any signs of intracranial bleeding, and if the patient shows clinical deterioration, immediate imaging should be obtained to rule out hemorrhagic complications. The guidelines suggest that pharmacologic thromboprophylaxis should be continued for at least 7-10 days for patients undergoing major surgery for cancer 1, but the duration of thromboprophylaxis for patients with hydrocephalus and VP shunt should be determined on a case-by-case basis, considering the patient's individual risk factors and clinical status.
From the Research
Hydrocephalus and VP Shunt Procedure
- Hydrocephalus is a condition characterized by an accumulation of cerebrospinal fluid (CSF) in the brain, often requiring a ventriculoperitoneal (VP) shunt procedure to manage the condition 2, 3, 4.
- The VP shunt procedure involves the placement of a shunt to divert excess CSF from the brain to the abdomen, where it can be absorbed 2, 3, 4.
VTE Prophylaxis
- Venous thromboembolism (VTE) prophylaxis is an important consideration in patients undergoing surgical procedures, including VP shunt placement 5, 6.
- The use of intermittent pneumatic compression (IPC) devices and low-molecular-weight heparin (LMWH) are common methods of VTE prophylaxis 5, 6.
- However, the safety and efficacy of VTE prophylaxis in patients with hydrocephalus and VP shunts is not well established, and the risk of bleeding must be carefully considered 5, 6.
Contraindications to VTE Prophylaxis
- There is no clear evidence to suggest that hydrocephalus and VP shunt procedure are contraindications to giving VTE prophylaxis 5, 2, 6, 3, 4.
- In fact, studies suggest that VTE prophylaxis can be safely used in patients with high risk of bleeding, including those with head and spinal trauma 6.
- However, the decision to use VTE prophylaxis in patients with hydrocephalus and VP shunts should be made on a case-by-case basis, taking into account the individual patient's risk factors and medical history 5, 6.