Risk of post-operative venous thromboembolism in patients with meningioma

Abstract

The surgical resection of meningiomas can be complicated by venous thromboembolism (VTE) in the post-operative period, but the exact incidence of this event is not known. Aim of this study was to assess the occurrence of VTE in patients operated for meningioma who underwent a post-operative clinical and objective screening for VTE. Patients undergoing meningioma resection between 2000 and 2010 who accepted to be investigated for VTE in the post-operative period were included in the study. The screening included daily clinical assessment, pulmonary perfusion scintigraphy (Q-SCAN) on day 2 and venous compression ultrasonography (CUS) of the lower limbs within day 7. The univariate and multivariate statistical analysis of risk factors for VTE included sex, age, presence of comorbidities, pre- and post-operative Karnofsky Performance scale (KPS), post-operative neurological worsening and post-operative walking ability. Two-hundred and seventy-five patients were included in the study. VTE was diagnosed in 82 patients (29.8%). Univariate analysis revealed that age ≥ 65 years, cardiovascular comorbidities, pre- and post-operative KPS < 80/100, post-operative neurological worsening and impaired post-operative walking ability were significantly associated with VTE. Multivariate analysis confirmed only age ≥ 65 years (p = 0.011) and post-operative KPS < 80/100 (p = 0.002) as independent risk factors for VTE. Patients operated for meningioma have a 30% risk of VTE. Age ≥ 65 years and post-operative KPS < 80 were independent risk factors for VTE.

Post-operative cardiovascular complications and time to recurrence in meningioma patients treated with versus without pre-operative embolization: a retrospective cohort study of 741 patients

“…Reports on associations of embolization with post-operative neurological outcomes are limited, with associations of embolization with cardiovascular adverse events or tumor recurrence not previously reported. To date, two recent studies explored associations of post-operative cardiovascular risk in meningioma patients [12,11]. In contrast to these studies, we did not detect associations of duration of surgery, older age and comorbidities with cardiovascular risk on multivariate analyses.…”

“…Meningioma surgery is associated with moderate or severe morbidity in a substantial fraction of patients [9][10][11][12]. The risk of post-operative thrombosis and pulmonary embolism after meningioma resection exceeds that of other brain tumors [13,14,11,12].…”

“…Meningioma surgery is associated with moderate or severe morbidity in a substantial fraction of patients [9][10][11][12]. The risk of post-operative thrombosis and pulmonary embolism after meningioma resection exceeds that of other brain tumors [13,14,11,12]. Underlying causes that have been identified include duration of surgery, older age, comorbidities and surgical complications [12,11], but a potential role of pre-operative tumor embolization has not been studied in detail.…”

Perioperative anticoagulation in patients with intracranial meningioma: No increased risk of intracranial hemorrhage?

“…Although both TE and PH do indeed affect patients' outcomes, in our study TE was found to have a far more severe effect on patients' outcomes. Previous data suggested high rates for reduced outcomes for patients with TE [39] or PH, but there was no direct comparison to post-hemorrhage outcomes. According to our findings, the definite risks of thromboembolism outweigh the harm caused by postoperative intracranial hemorrhage.…”

“…The thromboembolism rate of 3.38% is in keeping with our data. However, rates of DVT in screening studies revealed higher rates of asymptomatic TE [39]. Pre-existing data revealed a decreased risk for patients with continuous heparin treatment [40], although the study compared a combined chemical and mechanical regimen (IPC, leg raise) with subsequent chemical treatment and stockings.…”