346 Temporary Inferior Vena Cava Filter to Prevent Pulmonary Embolism in Thrombophilic Neurosurgery Patients

Abstract INTRODUCTION: Patients with symptomatic thrombophilia are treated with therapeutic anticoagulation. These patients can require neurosurgery. The patient must have their anticoagulation reversed before, during, and after surgery. After surgery they must be anticoagulated again. This entails a risk of embolic and hemorrhagic complications. Eighty-seven of these patients underwent neurosurgery between 2003 and 2015. Forty-two had a retrievable inferior vena cava filter before surgery and 45 had no filter placed. We report our results on this novel approach. METHODS: Prospective analysis of 87 thrombophilic patients. The author had his thrombophilic patients get an inferior vena cava (IVC) filter before elective spine/cranial surgery. The filter was left in for 2 weeks after surgery and then removed and anticoagulated. Other neurosurgeons did not have a filter placed in their thrombophilic patients. These patients were normalized a few days before surgery and anticoagulated at various time points after surgery. χ2 analysis of the results was performed. RESULTS: In the 45 patients with no filter, there were 6 pulmonary embolisms (PEs) of which 3 (10%) died acutely. There were 4 reoperations for spinal/cranial epidural hemorrhage after resumption of anticoagulation. Of the 41 patients with temporary IVC filters placed, there were no PEs, postoperative hemorrhages, or deaths. The filter was removed 2 weeks after surgery, when the patient was ambulatory and therapeutically anticoagulated. In 10, there was clot on the filter at removal. There were no complications due to the filter. χ2 analysis documented a significant reduction in the risk of PE, mortality, and postoperative hemorrhage (P < .01). CONCLUSION: A temporary IVC filter in thrombophilic neurosurgery patients is safe and significantly lessens the risk of PE, mortality, and perioperative hemorrhage.