• Vineeth Thirunavu, Viswajit Kandula, Parth Shah, Ketan Yerneni, Constantine L Karras, Zachary A Abecassis, Orin Bloch, Matthew Potts, Babak Jahromi, and Matthew C Tate.
• Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
• World Neurosurg. 2021 Sep 1; 153: e147-e152.

BackgroundVenous 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.MethodsA retrospective chart review was conducted for 159 patients at Northwestern University receiving 5000 units/0.5 mL 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.ResultsReceiving UFH TID was significantly associated with a lower rate of PE when compared with 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 with 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%).ConclusionsUFH TID dosing is associated with lower rates of PE when compared with BID dosing in patients undergoing craniotomy.Copyright © 2021 Elsevier Inc. All rights reserved.

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