Precision Medicine for Individualized VTE Prophylaxis in the Neurosurgical Patient

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Venous thromboembolism prophylaxis is a contentious aspect of common management of all neurosurgical patients, and even more controversial in trauma and critical care. This topic is poorly addressed in neurosurgical training, mostly relying on idiosyncratic approaches when going into more pragmatic clinical details than in the overarching principles clearly stipulated in the BTF guidelines. EAST vs. WEST consensus statements also give conflicting messages. The hematology, chest, trauma, neurotrauma, neurosurgery, critical care, vascular neurology and neurocritical care communities give dissonant guidance on that topic.

Registration Fee

AANS Members	$49
Non-members	$79

CME Accreditation

The AANS designates this activity for a maximum of 2.0 AMA PRA Category 1 Credits™.

Learning Objectives

After completing this educational activity, participants should be able to:

Compare and reconcile ACCP, AHA, BTF, NCS, neurosurgical and critical care guidelines as well as their respective stratification by subgroups of neurosurgical patients.
Identify subgroup-specific pragmatic prophylactic strategies with early mobilization, use of intermittent pneumatic compression and early adequate tailored anticoagulation.
Utilize risk assessment models for thrombosis and hemorrhage in various surgical groups and neurosurgical critical care subgroups.
Adopt individualized prophylaxis by neurosciences subgroups, encompassing neurotrauma, craniotomy, skull base surgery, spinal surgery and subarachnoid hemorrhage as well as decompressed malignant infarcts, decompressed intracerebral hemorrhage, other critical illnesses.

Faculty

Moderator:	Rocco A. Armonda, MD, FAANS
Panelists:	Geoffrey T. Manley, MD, PhD, FAANS Daniel Bernard Michael, MD, PhD, FAANS Jeffrey M. Sorenson, MD, FAANS Jamie S. Ullman, MD, FAANS

This educational activity was recorded at the 2019 AANS Annual Scientific Meeting.

Disclosure Information

The AANS controls the content and production of this CME activity and attempts to ensure the presentation of balanced, objective information. In accordance with the Standards for Commercial Support established by the Accreditation Council for Continuing Medical Education (ACCME), speakers, paper presenters/authors and staff (and the significant others of those mentioned) are asked to disclose any relationship they or their co-authors have with commercial interests, which may be related to the content of their lecture.

The ACCME defines “relevant financial relationships” as financial relationships in any amount occurring within the past 12 months that create a conflict of interest. Relationship refers to receipt of royalties, consultantship, funding by research grant, receiving honoraria for education service elsewhere or any other relationship to a commercial interest that provides sufficient reason for disclosure.

It is the policy of the AANS that all individuals in a position to affect the content of a CME activity disclose relationships that they or their spouse/partner have with commercial entities. Further, should any such relationship be determined to be in possible conflict of interest as it relates to the individual’s proposed role in the CME activity, such conflicts of interest will be resolved prior to confirmation of the individual’s participation.

All potential conflicts of interest have been reviewed by an effective peer review committee to ensure the content is valid and aligned with the interest of the activity audience.

Speakers, paper presenters/authors and staff (and the significant others of those mentioned) who have disclosed a relationship with commercial interests whose products may be relevant to their presentation are listed below.

Name	Organization	Relationship
Jamie S. Ullman, MD, FAANS	HeliusMedical corp	Other Financial Support

Those who have reported they do not have any relationships with commercial interests:

Rocco A. Armonda, MD, FAANS
Geoffrey T. Manley, MD, PhD, FAANS;
Daniel Bernard Michael, MD, PhD, FAANS;
Jeffrey M. Sorenson, MD, FAANS;

Disclaimer

The opinions expressed in this educational activity are those of the author and do not necessarily represent the views of the grant provider or the AANS. This educational activity does not endorse one particular type of instrumentation, nor is it intended to dictate an exclusive course of management. It presents one of numerous recognized methods of clinical practice for consideration by physicians for incorporation into their practices. Variations of practice taking into account the needs of the individual patient, resources and limitations unique to the institution or type of practice may be appropriate. Disclosure about patient confidentiality, standards of care or course of management does not imply endorsement or disapproval of products.

Please Note: It is recognized that the use of non-FDA approved devices is described in some of the published material, but these techniques are often the standard of care and may be of value to the patients served.