Abstracts

Rationale: The Epilepsy Monitoring Unit (EMU) is a unique hospital environment where patients electively undergo admission with the hopes of recreating events for specific diagnostic or management purposes.  However, in doing so, these patients are subjected to risks inherent to achieving such goals.  One such risk, venous thromboembolisms (VTE), is a well-known an often preventable complication of hospitalization.  Most patients are admitted to the EMU under the assumption that they are at low risk for VTE, with incidence equal to that of the outpatient population (0.01-0.1% annually)¹.  However, unlike the outpatient population, safety measures enforced in the EMU contribute to temporary risk factors (immobility, duration of travel, hospitalization itself) that increase the risk of thrombotic events.  VTE incidence and prevention among all-comers to the EMU have yet to be studied extensively with most institutions currently tailoring their practices to each individual case as appropriate.  This study sought to report the incidence of VTE at a level 4 epilepsy center and the subsequent application of a VTE prophylaxis strategy. Methods: A retrospective review of the electronic medical record was conducted on all patients admitted to the EMU at Mayo Clinic Arizona between January 2011 and December 2017.  All patients over the age of 18 undergoing scalp EEG monitoring for spell classification, pre-surgical evaluation, seizure localization/quantification and medication management were included in the study. In October 2015 a VTE protocol was initiated based upon risk stratification.  Each patient received 1 point for prolonged immobility with additional points for age >40, lower limb paralysis, thrombophilia, malignancy and/or prior VTE.  Patients scoring 2+ points received pharmacologic prophylaxis. Patients with a discharge diagnosis of pulmonary emboli or deep vein thrombosis, were considered positive for VTE. Results: A total of 1357 patients (M 540; F 817) were admitted to the EMU for scalp EEG monitoring over a seven year period.  Average age of admission for males was 45 and females 43 years.  A total of three patients were confirmed as having VTE with annual incidence of 0.03%. All patients were male (two patients > 40 years of age; one patient < 40 with a history of hypercoagulability, prior DVT admitted on anti-coagulation). Subsequent to the initiation of prophylaxis in October 2015 there have be no recorded VTEs. Furthermore, complications such as hematuria, bleeding or hematoma formation have not been identified. Conclusions: Our findings reflect that in all-comers admitted to the EMU for scalp EEG monitoring, VTEs may occur with higher incidence than is seen in the general population.  Additionally, VTE prophylaxis in patients with identified risk can be safely initiated in EMU patients and may be an effective practice.  However, further investigation with larger cohorts will be required to identify the safest and most effective practices to prevent VTEs in the EMU.  1. Cushman M. Epidemiology and risk factors for venous thrombosis. Semin Hematol 2007; 44(2):62–69. Funding: No funding was received in support of this abstract.