Tuesday, April 16
7:00 am - 9:00 am
201 Precision Medicine for Individualized VTE Prophylaxis in the Neurosurgical Patient, Including Trauma and Critical Care
Moderator(s): Rocco A. Armonda, MD, FAANS
Panelist(s): Geoffrey T. Manley, MD, PhD, FAANS; Daniel Bernard Michael, MD, PhD, FAANS; Jeffrey M. Sorenson, MD, FAANS; Jamie S. Ullman, MD, FAANS
Venous thromboembolism prophylaxis is a contentious aspect of our common management of all neurosurgical patients, and even more controversial in trauma and critical care. This topic is poorly addressed in neurosurgical training, mostly relying on idiosyncratic approaches, when going into more pragmatic clinical details than the overarching principles clearly stipulated in the BTF guidelines. EAST vs. WEST consensus statements also give conflicting messages. The hematology, chest, trauma, neurotrauma, neurosurgery, critical care, vascular neurology and neurocritical care communities
give dissonant guidance on that topic. We propose to cover all points of views and reconcile.
Individual lectures will cover:
1. Compare and reconcile ACCP, AHA, BTF, NCS, neurosurgical & critical care guidelines
2. Align practices with modern critical care experts guidance, preferring LMWH and even weight-based and risk-adjusted as well as anti-Xa-guided LMWH usage.
3. Learn subgroup specific pragmatic prophylactic strategies with early mobilization, use of intermittent pneumatic compression and early adequate anticoagulation.
4. Become familiar with eminence-and evidence-based risk assessment models for thrombosis and hemorrhage in various groups.
5. Risk assessment models for thrombotic and for hemorrhagic risks, in the medical surgical and critical care arenas.
6. Learn the key concept of "Likelihood to be helped vs. harmed" i.e. "clinical benefit ratio" for any intervention: a great concept but pooled from large heterogeneous groups and not going beyond mortality of symptomatology, whereas QOL improvement should be used in these calculations.
7. Adopt individualized prophylaxis by neurosciences subgroups, encompassing chronic neurologic impairments, acute ischemic stroke, intracerebral hemorrhage, critical illness, neurotrauma, craniotomy, skull base surgery, spinal surgery and subarachnoid hemorrhage.
- Compare and reconcile ACCP, AHA, BTF, NCS, neurosurgical & critical care guidelines and their respective stratification by subgroups of neurosurgical patients.
- Identify subgroup specific pragmatic prophylactic strategies with early mobilization, use of intermittent pneumatic compression and early adequate tailored anticoagulation.
- Utilize risk assessment models for thrombosis and hemorrhage in various surgical groups and neurosurgical critical care subgroups.
- Adopt individualized prophylaxis by neurosciences subgroups, encompassing neurotrauma, craniotomy, skull base surgery, spinal surgery and subarachnoid hemorrhage.
- As well as decompressed malignant infarcts, decompressed intracerebral hemorrhage, other critical illnesses.