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Background <p>Venous thromboembolism (VTE) is a risk in neurosurgery, but data for adults undergoing ventriculoperitoneal (VP) shunt insertion are limited. The safety of post-operative pharmacological thromboprophylaxis in this population remains unclear due to concerns about bleeding. This study evaluated the safety of post-operative pharmacological thromboprophylaxis after VP shunt insertion in adults in relation to VTE and haematoma risk.</p> Methods <p>This retrospective cohort study included 246 adult patients who underwent primary VP shunt insertion at a tertiary centre between 2017 and 2021. Data on demographics, aetiology, surgery, radiological imaging, pharmacological thromboprophylaxis, and outcomes (VTE, post-operative haematomas) were collected and reviewed. Univariate analysis and propensity-matching were used to compare outcomes.</p> Results <p>Median age was 63&#xa0;years (range 17–90&#xa0;years); common hydrocephalus aetiologies were tumour (32.9%) and normal pressure hydrocephalus (30.5%). Pharmacological thromboprophylaxis (median post-operative day 1) was given to 76.0% (<i>n</i> = 187), alongside universal mechanical prophylaxis. One VTE (pulmonary embolism, 0.4%) event occurred. Routine post-operative imaging detected 12 haematomas (4.9%); 2 (0.8%) were clinically significant: 1 intracerebral haemorrhage requiring surgical evacuation and 1 managed conservatively. Pharmacological thromboprophylaxis did not significantly increase the risk of post-operative haematoma formation overall (<i>p</i> &gt; 0.99) and in a propensity score matched subgroup analysis that controlled for confounders (<i>p</i> = 0.36).</p> Conclusion <p>In this study, we demonstrate that early pharmacological thromboprophylaxis after primary VP shunt insertion appears to have an acceptable safety profile without significantly increasing haematoma risk. Our findings require validation in future multicentre cohorts.</p>

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Pharmacological thromboprophylaxis following ventriculoperitoneal shunt insertion: a single-centre experience of thromboembolic and bleeding outcomes

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月29日

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  • Adnan R. Alnaser,
  • Furkan Zurel,
  • Abed Alnsour,
  • Omar N. Pathmanaban,
  • Helen Maye,
  • Catherine McMahon,
  • Matthew Bailey,
  • Mueez Waqar

摘要

Background

Venous thromboembolism (VTE) is a risk in neurosurgery, but data for adults undergoing ventriculoperitoneal (VP) shunt insertion are limited. The safety of post-operative pharmacological thromboprophylaxis in this population remains unclear due to concerns about bleeding. This study evaluated the safety of post-operative pharmacological thromboprophylaxis after VP shunt insertion in adults in relation to VTE and haematoma risk.

Methods

This retrospective cohort study included 246 adult patients who underwent primary VP shunt insertion at a tertiary centre between 2017 and 2021. Data on demographics, aetiology, surgery, radiological imaging, pharmacological thromboprophylaxis, and outcomes (VTE, post-operative haematomas) were collected and reviewed. Univariate analysis and propensity-matching were used to compare outcomes.

Results

Median age was 63 years (range 17–90 years); common hydrocephalus aetiologies were tumour (32.9%) and normal pressure hydrocephalus (30.5%). Pharmacological thromboprophylaxis (median post-operative day 1) was given to 76.0% (n = 187), alongside universal mechanical prophylaxis. One VTE (pulmonary embolism, 0.4%) event occurred. Routine post-operative imaging detected 12 haematomas (4.9%); 2 (0.8%) were clinically significant: 1 intracerebral haemorrhage requiring surgical evacuation and 1 managed conservatively. Pharmacological thromboprophylaxis did not significantly increase the risk of post-operative haematoma formation overall (p > 0.99) and in a propensity score matched subgroup analysis that controlled for confounders (p = 0.36).

Conclusion

In this study, we demonstrate that early pharmacological thromboprophylaxis after primary VP shunt insertion appears to have an acceptable safety profile without significantly increasing haematoma risk. Our findings require validation in future multicentre cohorts.