Pharmacological thromboprophylaxis following ventriculoperitoneal shunt insertion: a single-centre experience of thromboembolic and bleeding outcomes
- 1Department of Neurosurgery, Salford Royal NHS Foundation Trust, Northern Care Alliance, Salford, Manchester United Kingdom
- 2Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, United Kingdom
Abstract
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.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00701-026-06923-2.
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BibTeX
@article{alnaser2026pharmacological,
title = {{Pharmacological thromboprophylaxis following ventriculoperitoneal shunt insertion: a single-centre experience of thromboembolic and bleeding outcomes}},
author = {Adnan R. Alnaser and Furkan Zurel and Abed Alnsour and Omar N. Pathmanaban and Helen Maye and Catherine McMahon and Matthew Bailey and Mueez Waqar},
journal = {Acta Neurochirurgica},
year = {2026},
month = jul,
doi = {10.1007/s00701-026-06923-2},
url = {https://doi.org/10.1007/s00701-026-06923-2},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Pharmacological thromboprophylaxis following ventriculoperitoneal shunt insertion: a single-centre experience of thromboembolic and bleeding outcomes
AU - Adnan R. Alnaser
AU - Furkan Zurel
AU - Abed Alnsour
AU - Omar N. Pathmanaban
AU - Helen Maye
AU - Catherine McMahon
AU - Matthew Bailey
AU - Mueez Waqar
PY - 2026
DA - 2026/07/29
JO - Acta Neurochirurgica
DO - 10.1007/s00701-026-06923-2
UR - https://doi.org/10.1007/s00701-026-06923-2
AB - 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. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1007/s00701-026-06923-2.
SN - 0001-6268
SN - 0942-0940
ER -