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Pulmonary Embolism Complicating Neurosurgical Procedures

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PERT Consortium Handbook of Pulmonary Embolism

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Abstract

Neurosurgical patients are at risk of developing pulmonary embolism (PE), and venous thromboembolism (VTE) more broadly. Risk factors putatively responsible include correlated patient-associated characteristics, intra- and perioperative factors, and pathophysiologic mechanisms associated with the underlying conditions being treated; the mechanistic antecedents fundamentally responsible for this increased risk are encapsulated by Virchow’s eponymous triad. Here we describe the epidemiology, natural history, neurosurgery-specific risk factors, and treatment and prophylaxis considerations of VTE/PE in the neurosurgical population. Specific subpopulations examined include cranial versus spine, neuro-oncology, cerebrovascular, trauma, and pediatrics. Various practical aspects of VTE/PE prophylaxis and treatment are reviewed, such as type, screening, timing, complications, and efficacy, with consideration of current guidelines along with a survey of the literature. Despite a myriad of existing studies examining VTE/PE prophylaxis and treatment in neurosurgical patients, consensus has yet to be reached on a set of recommendations given the challenge of balancing the bleeding risk of pharmacotherapy versus the benefit of prevention/treatment in an already vulnerable population. Ultimately, further work will be necessary to investigate the most effective therapeutic protocols for management of PE in the neurosurgical population.

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Authors and Affiliations

  1. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Jack Y. Ghannam, Bryan D. Choi & Brian V. Nahed

Authors
  1. Jack Y. Ghannam
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  2. Bryan D. Choi
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  3. Brian V. Nahed
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Correspondence to Brian V. Nahed .

Editor information

Editors and Affiliations

  1. Department of Medicine, Emory University Hospital Midtown, Atlanta, GA, USA

    Charles J. Grodzin

  2. Department of Medicine and Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA

    Geno J. Merli

  3. Vascular and Endovascular Surgery, Piedmont Heart Institute, Piedmont Healthcare, Atlanta, GA, USA

    Charles B. Ross

  4. Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA, USA

    Rachel Rosovsky

Section Editor information

  1. Division of Hematology and Oncology, Massachusetts General Hospital, Boston, Massachusetts, USA

    Rachel Rosovsky

  2. Department of Medicine, Emory University Hospital Midtown, Atlanta, Georgia, USA

    Charles J. Grodzin

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Ghannam, J.Y., Choi, B.D., Nahed, B.V. (2023). Pulmonary Embolism Complicating Neurosurgical Procedures. In: Grodzin, C.J., Merli, G.J., Ross, C.B., Rosovsky, R. (eds) PERT Consortium Handbook of Pulmonary Embolism . Springer, Cham. https://doi.org/10.1007/978-3-030-70904-4_26-1

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  • DOI: https://doi.org/10.1007/978-3-030-70904-4_26-1

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  • Print ISBN: 978-3-030-70904-4

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