Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors

Abstract

Objective The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. Methods All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. Results Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.026–1.052; P<0.0001], high grade glioma (OR, 1.702; 95% CI, 1.176–2.465; P=0.005), older age (OR, 1.033; 95% CI, 1.020–1.046; P<0.0001), hypertension (OR, 1.785; 95% CI, 1.180–2.699; P=0.006), and motor deficit (OR, 1.854; 95% CI, 1.244–2.763; P=0.002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage. Discussion The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.

Development of venous thromboembolism (VTE) in patients undergoing surgery for brain tumors: Results from a single center over a 10year period

“…Multiple studies have reported the relationship between brain tumor grade and VTE development. Uniformly, patients with high-grade gliomas have been shown to have a higher incidence of VTE [10][11][12][13]48,53,54]. We also noted a significant association between age and grade, but not cardiovascular disease or ambulatory status.…”

“…One of the most recent studies of DVT/VTE incidence in brain tumor patients undergoing craniotomy reports a DVT incidence of only 3.0% [48]. Higher rates of VTE/DVT in the patients in the present study (13.7%) may be a result of vigorous testing for DVT and PE at our institution during this period.…”

“…In one of the most recent studies involving VTE and brain tumors, Chaichana et al evaluated 4293 brain tumor patients for VTE [48]. They found that the preoperative factors that were independently associated with VTE development were poorer Karnofsky Performance Scale score, high-grade tumors, older age, hypertension, and a pre-operative motor deficit.…”

“…Other studies have demonstrated significance for a number of DVT predictors [3,6,16,18,42,[48][49][50][51][52]. In one of the most recent studies involving VTE and brain tumors, Chaichana et al evaluated 4293 brain tumor patients for VTE [48].…”

Venous thromboembolism (VTE) and glioblastoma

“…Several risk factors have previously been associated with the development of VTE in GBM patients including functional status, paresis, residual disease, obesity, chemotherapy and vascular endothelial growth factor targeted treatment [5]. It is also well established that the risk for VTE is high in the post surgical period and can extend up to 30 days after the surgical procedure [6]. However, it is unclear if an increased risk of VTE remains after the post-surgical period.…”