Labormarker und Risiko für sekundäre hämorrhagische Komplikationen nach Antikoagulation aufgrund venöser Thromboembolie in der frühen postoperativen Phase nach neurochirurgischen Eingriffen

Abstract

Deep vein thrombosis (DVT) and venous thromboembolism (VTE) are serious complications following neurosurgical procedures. While anticoagulation is essential for treatment, it also increases the risk of postoperative hemorrhagic complications, particularly in the early postoperative period. Evidence-based recommendations regarding the optimal management of anticoagulation remain limited. This retrospective study included 173 patients with postoperative DVT or VTE treated at the Department of Neurosurgery, University Hospital Tübingen, between 2008 and 2017. The aim was to identify risk factors for severe thromboembolic outcomes and hemorrhagic complications associated with anticoagulation. A severe clinical course occurred in 32.4% of patients, and 5.8% of thromboembolic events were fatal. Spinal procedures, prolonged activated partial thromboplastin time (aPTT), thrombocytopenia, and reduced prothrombin time (Quick value) were associated with an increased risk of fatal outcomes. Severe hemorrhagic complications occurred in 6.6% of patients. Although D-dimer levels did not predict VTE severity, elevated D-dimer levels after diagnosis were associated with an increased risk of hemorrhagic complications. These findings highlight the challenges of anticoagulation following neurosurgical procedures and suggest that D-dimer levels may help identify patients at increased risk of postoperative bleeding, thereby supporting safer anticoagulation management.