Neurosurgical patients and in particular those with spinal injuries and brain tumours are prone to venous thromboembolism (Fig. 3). Laboratory tests are of limited use in identifying those in a prothrom-botic state. It is more important to identify the multiple risk factors contributing to thromboembolism. In the neurosurgical patient with a brain tumour these can include impaired mobility and the use of procoagulants such as steroids, chemotherapeutic and hormonal agents. Furthermore tumours themselves are believed to secrete procoagulant factors such as tissue factor and fibrinolytic inhibitors.
The measures that are used are still based on the notion that venous thromboembolism is a consequence of trauma to the vessel wall, stasis and hypercoagulability as first described by the German physician RudolfVirchow.
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