Clinical Characteristics of Patients with Pulmonary Embolism and Concomitant Deep Vein Thrombosis Following Neurosurgery: A Five-year Single-institution Study

Introduction: Neurosurgical patients often present with risk factors for venous thromboembolism (VTE) such as long duration of surgical intervention, postoperative immobility, and prolonged need for mechanical ventilation and sedation. This study aims to understand the clinical risk factors leading to the development of pulmonary embolism (PE) in patients with deep vein thrombosis (DVT) to identify appropriate screening and prophylactic measures.

Methods: A retrospective analysis of all the patients seen by the neurological surgery service at a single institution between January 1, 2014 and December 31, 2018 was performed. Of the 5895 patients seen, 70 patients had a positive diagnosis of DVT while 13 had both DVT and PE. Patient demographics and comorbidities were assessed using Student’s t-tests and chi-squared analyses. Multivariate logistic regression was performed to identify independent predictors of PE in patients with diagnosis of DVT.

Results: Patients with both DVT and PE were significantly younger than those with DVT only (49.77 ± 14.50 vs. 62.31 ± 15.58) and had lower BMI (27.96 ± 6.68 vs. 30.79 ± 8.53). There were no statistically significant differences in the rates of hypertension, end-stage renal disease, history of drinking/smoking, coronary artery disease, hypertension intravenous drip, days spent on mechanical ventilation or intracranial pressure elevation between the two groups. Pre-existing coagulopathies were associated with developing PE, but administration of anticoagulants on admission was not. Multivariate logistic regression analysis revealed that none of the assessed comorbidities were predictors of PE development.

Conclusion : Age and BMI were the only demographic differences observed in patients with DVT who develop concomitant PE compared to those who do not. Hypertension, diabetes, coagulopathy, coronary artery disease, and end-stage renal disease were not independent predictors of PE. More research is warranted to understand the development and management of VTE in patients following neurosurgery.