Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas

Abstract

Patients with brain tumors including intracranial meningiomas are at increased risk for developing deep vein thrombosis (DVTs) and suffering thromboembolic events (VTEs). Many surgeons are concerned that early use of low dose enoxaparin may increase the risk of intracranial hemorrhage which outweighs the benefit of DVT/VTE reduction. We aimed to address concerns around the use of enoxaparin after meningioma resection in the development of postoperative intracranial hemorrhages and DVT/VTEs. This is a retrospective review of 86 patients with intracranial meningiomas who underwent craniectomy and surgical resection of the mass, treated by one attending surgeon at UCSF Medical Center between 2000 and 2005. Within 48 h after surgery patients treated 2003-2005 routinely received enoxaparin therapy unless there was documented intracranial hemorrhage, lumbar subarachnoid drain, enoxaparin hypersensitivity, or thrombocytopenia (n = 24). These were compared to a cohort treated 2000-2002 who did not receive the drug (n = 62). Exclusion criteria were prior VTEs or coagulopathies. The groups were similar in tumor and surgical characteristics. Enoxaparin therapy did not increase the incidence of intracranial hemorrhage following surgical meningioma resection and the incidence of DVTs/VTEs was 0% (n = 0) versus 4.8% (n = 3) in the non-enoxaparin group. Results did not reach statistical significance. In this retrospective study, postoperative administration of enoxaparin following meningioma resection does not increase the risk of intracranial hematoma though enoxaparin administration may slightly decrease the incidence of post-surgical thromboembolic events. Due to study design and power, we were not able to demonstrate DVT/VTE reduction with statistical significance.

Modern surgical outcomes following surgery for sphenoid wing meningiomas

“…The incidence of postoperative intracranial hemorrhage was no different in the patient groups before or after routine prophylaxis was begun. 6 …”

Outcome and survival following primary and repeat surgery for World Health Organization Grade III meningiomas

“…The incidence of postoperative intracranial hemorrhage was no different in the patient groups before or after prophylaxis was initiated. 4 Regardless of preoperative seizure history, all patients also received loading doses of an antiepileptic agent at the time of surgery (Dilantin initially, Keppra more recently), which was continued for 1 week postoperatively and was then discontinued, following guidelines for patients with severe traumatic brain injury.…”

The incidence of postoperative thromboembolic complications following surgical resection of intracranial meningioma. A retrospective study of a large single center patient cohort

“…Apart from the immobilization of the patients in the postoperative recovery period, tumor-induced hemostatic changes resulting in a hypercoagulable state may elicit VTE [10,[15][16][17][18]. Other risk factors are patient age and weight, a history of thromboembolic events, extent of surgical blood loss, and presence of malignancy [9,10,16,19].…”

“…Pharmacologic agents that have gained great importance in prophylaxis are low-molecular weight heparins, despite the potential risk of hemorrhage [5,6,15,[21][22][23][24][25][26][27]. There remains, however, controversy about the prophylactic treatment of VTE with either or both pharmacologic and mechanic means in the treatment of neurosurgical patients with meningioma, despite an increasing body of confirmatory evidence [1,2,8,20,22,25,28,29].…”