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OBJECTIVE: This study employed a decision analytic model to assess the risks and benefits of adding anticoagulants to mechanical prophylaxis for preventing DVT in the craniotomy patient. METHODS: We created a decision tree modeling pneumatic compression devices alone, compression plus minidose unfractionated heparin and compression plus low molecular weight heparin. Post operative outcomes included DVT, PE and intracranial hemorrhage. Probabilities for the tree were obtained from a MEDLINE search of English-language literature. Searches were supplemented by reviewing the bibliographies of selected articles. We calculated weighted averages of expected complications from each treatment option. We included only clinically evident DVT and PE and only cases of post-craniotomy hemorrhage that required emergency reoperation. RESULTS: The outcomes of all three strategies are close to 1 because complications, no matter how severe, are uncommon. We used sensitivity analyses to examine the robustness of the apparent superiority of the no heparin strategy. The incidence of pulmonary embolism had the greatest influence on outcome . Its incidence (without heparin) was varied from 0 to 3%. It is the only variable which impacts strategy; if the incidence doubles from baseline to 1.4%, adding heparin begins to yield better outcomes than mechanical prophylaxis alone. CONCLUSION: The clear advantage of heparin prophylaxis in general surgery is offset by increased risk of intercranial hemorrhage in craniotomy patients. The effectiveness of the methods are similar, but mechanical prophylaxis without heparin looks best unless the PE incidence doubles.
See more of Poster Session - Utility Theory; Health Economics; Patient & Physician Preferences; Simulation; Technology Assessment
See more of The 26th Annual Meeting of the Society for Medical Decision Making (October 17-20, 2004)