Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy

Algattas, Hanna; Kimmell, Kristopher T.; Vates, G. Edward; Jahromi, Babak S.

doi:10.1016/j.wneu.2015.06.033

Cited by 32 publications

(23 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several reports demonstrated the occurrence of ICH expansion following enoxaparin prophylaxis in trauma patients and recommended the use of VTE prophylaxis in selected patients with multiple risk factors for VTE following TBI. 7,16,17 Reiff et al 4 demonstrated that isolated TBI is an independent risk factor for VTE and PE, as it increases the risk of VTE by 3-4 fold. Byrne et al 9 demonstrated that the use of prophylactic enoxaparin in isolated severe TBI patients significantly reduced the risk of VTE without increasing the risk of neurosurgical procedures or death.…”

Section: Discussionmentioning

confidence: 99%

<p>The Safety of Early Thromboembolic Prophylaxis in Closed Traumatic Intracranial Hemorrhage</p>

Jamous¹

2020

OAEM

View full text Add to dashboard Cite

Background: Venous thromboembolism (VTE) is a major cause of morbidity and mortality in patients with traumatic brain injury (TBI); this study is testing the safety of enoxaparin use for the prevention of venous thromboembolism in this group of patients. Patients and Methods: From January 2016 to May 2018, 46 patients (36 males, 10 females) with closed traumatic intracranial bleeding received early (ie, within 72 hours) venous thromboembolic prophylaxis with 40 mg of enoxaparin. Patients with traumatic intracranial hemorrhage were followed up both clinically and with repeated brain computed tomography to examine the safety of enoxaparin VTE prophylaxis. Results: The age of the patients ranged from 16-91 years (43.9±25.8 years). Glasgow coma score ranged from 5-15 (9.9±4.7). Twenty patients had mild TBI (GCS 15-13), 17 patients had moderate TBI (GCS 12-9), and nine patients had severe TBI (GCS≤8). Brain computed tomography showed variable types of brain injuries. Non-surgical management was applied for 18 patients. Craniotomy and surgical evacuation of significant (≥1cm in maximum diameter) EDH and/or SDH was carried out in 26 patients. External ventricular drain was inserted in two patients with significant IVH. Thirty-eight patients had good overall outcome, eight patients showed poor outcome. None of the reviewed patients developed clinical deterioration and/or progression of the intracranial bleeding on follow-up brain CT scans. Conclusion: Enoxaparin is a safe prophylaxis against venous thromboembolism in patients with traumatic closed intracranial bleeding.

show abstract

Section: Discussionmentioning

confidence: 99%

<p>The Safety of Early Thromboembolic Prophylaxis in Closed Traumatic Intracranial Hemorrhage</p>

Jamous¹

2020

OAEM

View full text Add to dashboard Cite

show abstract

“…Outcome and Complications After POH The overall incidence of venous thromboembolism (VTE) in patients undergoing craniotomy is 2.6%e3.5%, 17,[63][64][65][66] whereas in neoplasm neurosurgery, the rates are remarkably higher, ranging from 3% to 26%, even with DVT prophylaxis. 55,56,67 In the current series, the occurrence of VTE in neurosurgical patients with POH was 5.7%, and in postcraniotomy patients with POH, it was 13.0%.…”

Section: Poh Risk Factorsmentioning

confidence: 99%

“…One possible explanation could be that clinically significant POH leads to reoperation and often also to prolonged ventilator dependence with bed rest, which all independently are well-known VTE risk factors. 56,63,64,67,68 It is therefore challenging to start DVT prophylaxis in postcraniotomy patients with a bleeding complication, but on the other hand, in patients with a high risk for thrombosis, DVT prophylaxis is nevertheless indicated, even if they have high bleeding risk or have had a hemorrhagic complication. An individualized multidisciplinary approach in these patients might be the key component in balancing the risks of bleeding and thrombosis.…”

Section: Poh Risk Factorsmentioning

confidence: 99%

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

et al. 2017

View full text Add to dashboard Cite

show abstract

“…1 The risk of VTE is especially prominent in neurosurgical procedures, especially craniotomies for brain tumors. [1][2][3][4][5][6][7][8][9][10] VTE can result in deep vein thrombosis (DVT), which can cause significant pain and morbidity, and pulmonary embolism (PE), which can be fatal.…”

mentioning

confidence: 99%

“…2,[15][16][17] The increased rate of VTE in patients undergoing craniotomy for brain tumors increases mortality and morbidity among these patients, and can also increase length of stay and associated healthcare costs. 3,18,19 Due to the high risks of VTE, both chemical and mechanical prophylaxes are employed to prevent VTE development. 1 While developing perioperative VTE is relatively common, these modalities have previously been shown to reduce the prevalence of VTE, especially in patients with preexisting risk factors, such as older age, higher body mass index (BMI), and bleeding disorders.…”

mentioning

confidence: 99%

Venous Thromboembolism in Patients Undergoing Craniotomy for Brain Tumors: A U.S. Nationwide Analysis

Coté

Dubois

Karhade

et al. 2016

Semin Thromb Hemost

View full text Add to dashboard Cite

Patients who undergo craniotomy for brain tumor have an increased risk of developing venous thromboembolism (VTE). Using the National Surgical Quality Improvement Program (NSQIP) registry, patients undergoing craniotomy for brain tumor from 2006 and 2014 were analyzed to identify risk factors for postoperative VTE. The study population, identified by Current Procedural Terminology codes, included all NSQIP-reported patients who underwent a craniotomy for brain tumor resection. There were 629 instances of VTE among 19,409 craniotomies for brain tumor (3.2%) recorded in NSQIP. Occurrence of VTE was associated with other postoperative complications on univariate analysis, including pneumonia, respiratory failure, stroke, and sepsis (all < 0.001). On multivariate analysis, independent predictors of VTE included age 46 to 57 years (odds ratio [OR], 1.432; = 0.006), 57 to 66 years (OR, 1.550; = 0.001), or over 66 years (OR, 2.493; < 0.001), body mass index (BMI) over 32.1 kg/m (OR, 1.835; < 0.001), functional dependence (OR, 1.657; < 0.001), ventilator dependence (OR, 2.516; < 0.001), steroid use (OR, 1.661; < 0.001), prior sepsis (OR, 1.845; < 0.001), and total operative time 183 to 271 minutes (OR, 1.462; = 0.032) and longer than 271 minutes (OR, 1.945; < 0.001). VTE occurs in approximately 3% of patients undergoing craniotomy for brain tumor resection. Independent predictors for developing VTE include older age, higher BMI, recent steroid use, and total operative time.

show abstract

Analysis of Venous Thromboembolism Risk in Patients Undergoing Craniotomy

Cited by 32 publications

References 32 publications

<p>The Safety of Early Thromboembolic Prophylaxis in Closed Traumatic Intracranial Hemorrhage</p>

<p>The Safety of Early Thromboembolic Prophylaxis in Closed Traumatic Intracranial Hemorrhage</p>

Incidence of Postoperative Hematomas Requiring Surgical Treatment in Neurosurgery: A Retrospective Observational Study

Venous Thromboembolism in Patients Undergoing Craniotomy for Brain Tumors: A U.S. Nationwide Analysis

Contact Info

Product

Resources

About