Developing a neurosurgery venous thromboembolism (VTE) guideline – achieving national consensus in New Zealand, a systematic approach.

Patients undergoing neurosurgical operations are at risk of venous thromboembolism (VTE), which includes deep vein thrombosis (DVT) and pulmonary embolism (PE). This risk requires assessment alongside the risk of bleeding, and these two complications inform decision making around the use of pharmacological VTE prophylaxis. Whilst mechanical devices such as intermittent pneumatic compression devices (IPCDs) are widely utilised from prior to surgery until the patient is mobile postoperatively, the decision to initiate chemoprophylaxis is more complex, due to the risk of postoperative haemorrhage in this high-risk population. Furthermore, the diagnosis of VTE makes treatment decisions more difficult, due to the potential for increased bleeding with therapeutic anticoagulation in this population. Preventative measures for VTE in the neurosurgical population vary significantly worldwide, nationally in New Zealand and within neurosurgery departments, however prevention is fundamental as treatment of VTE has increased risks for patients, is costly and causes longer hospital stays. Prevention really is better than cure. A team approach, integrating nurses and doctors is fundamental in the prevention, diagnosis and treatment of VTE. This article reviews the journey to a VTE National consensus guideline in New Zealand.