Enoxaparin Increases the Incidence of Postoperative Intracranial Hemorrhage when Initiated Preoperatively for Deep Venous Thrombosis Prophylaxis in Patients with Brain Tumors

Dickinson, Lawrence D.; Miller, Larry D.; Patel, Chirag P.

doi:10.1097/00006123-199811000-00039

Cited by 233 publications

(156 citation statements)

References 24 publications

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“…Prior studies have shown that prophylactic treatment with low molecular weight heparin leads to fewer vascular complications such DVT and VTEs [10][11][12][13][14][15]. However, the risk of postoperative hematoma has been shown to increase with early anticoagulation [16]. Some studies have evaluated the use of heparin or enoxaparin with different regimens and different doses and there is no good consensus for preferred postoperative anticoagulation regimen.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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.

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Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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“…Furthermore, the perception of high VTE rates among these patients might also impact clinical outcomes by leading to overly aggressive VTE prophylaxis. For instance, in a series of patients undergoing neurosurgery, Dickinson et al, 21 administered enoxaparin 30 mg subcutaneously every 12 hours, with the first dose given before surgery. Whereas preoperative DVT prophylaxis has demonstrated benefit in the highest-risk VTE populations, such as patients undergoing elective hip arthroplasty, 22 this study was terminated when 5 of 46 patients (11%) sustained clinically significant intracranial hemorrhage before administration of the second enoxaparin dose.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis

Gerber

Segal

Salhotra

et al. 2007

Cancer

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The long‐term disease‐free survival in patients with metastatic transitional cell carcinoma (TCC) is still considerably low. Novel chemotherapeutic agents are needed to decrease the morbidity and mortality of TCC. In this study, we have evaluated several epigenetic modifiers for their therapeutic application in bladder cancer. Both histone deacetylase inhibitors (FK228, TSA) and DNA hypomethylating agent (5‐Azacytidine) were tested using in vitro assays such as cell viability, cell cycle analysis and western blot to determine their mechanisms of action. Drug combination experiments were also designed to study any additive or synergistic effects of these agents. In addition, two bladder cancer xenograft models (one subcutaneous and one orthotopic) were employed to assess the therapeutic efficacy of these agents in vivo. Three agents exhibited various growth inhibitory effects on 5 different TCC cell lines in a dose‐ and time‐dependent manner. In addition to G2/M cell cycle arrest, FK228 is more potent in inducting apoptosis than the two other single agents, and combination of both FK228 and 5‐Aza further enhances this effect. p21 induction is closely associated with FK228 or TSA but not 5‐Aza, which is mediated via p53‐independent pathway. Consistent with in vitro results, FK228 exhibited a significant in vivo growth inhibition of TCC tumor in both subcutaneous and orthotopic xenograft models. FK228 is a potent chemotherapeutic agent for TCC in vivo with minimal undesirable side effects. The elevated p21 level mediated via p53 independent pathway is a hallmark of FK228 mechanism of action. © 2007 Wiley‐Liss, Inc.

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“…Data on this association have been mixed. Some studies have demonstrated an increased rate of intracranial hemorrhage when VTE chemoprophylaxis is initiated preoperatively [45]. Other studies have demonstrated no statistically significant association between the two [75][76][77][78].…”

Section: Prophylaxis Chemicalmentioning

confidence: 99%

“…Several studies have compared the effectiveness of chemical anticoagulation with the effectiveness of mechanical prophylaxis [7,32,36,45,52,74,82]. Many of these studies show that combined prophylaxis has a higher effectiveness in preventing VTE without increasing risk to the patient than either method alone ( …”

Section: Combined Prophylaxismentioning

confidence: 99%

“…Studies have shown that other risk factors for VTE include age, sex, ethnicity, blood type, length of hospital stay, operative duration, and coagulation status [3,6,[8][9][10]14,[25][26][27][28][29][30][31][32][33][34][35][36][37][38]. Standard prophylactic measures for VTE include chemical anticoagulation, mechanical prophylaxis, and increased ambulation during the post-operative period [36,[39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54]. This paper seeks to review the relevant and current literature on VTE in brain tumor patients, with particular focus on the risk factors and presenting symptoms of VTE, treatment options for those with VTE, and a review of current prophylactic measures for VTE.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

Coté¹,

Smith

2015

J Hematol Thrombo Dis

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Venous thromboembolism (VTE) is a relatively common and well-described condition, affecting approximately 1-2% of the general population. VTE can lead to significant morbidity and death via pulmonary embolism (PE). During the post-operative period, VTE occurs at higher rates due to natural thrombotic responses to injury and limited post-operative mobility. In general, rates of post-operative VTE are higher in patients undergoing operations for cranial and spinal lesions than for lesions of other types, a phenomenon that is not fully explained. Several studies have demonstrated that other risk factors for VTE include age, sex, ethnicity, hospital stay length, and coagulation state. Aggressive chemical and mechanical measures for VTE prophylaxis are indicated in the postoperative period to prevent the formation of VTE. Here we review the literature on VTE in brain tumor patients, with a focus on their etiology, diagnosis, treatment, and prophylaxis.

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Enoxaparin Increases the Incidence of Postoperative Intracranial Hemorrhage when Initiated Preoperatively for Deep Venous Thrombosis Prophylaxis in Patients with Brain Tumors

Abstract: Enoxaparin therapy initiated at the time of anesthesia induction increases postoperative intracranial hemorrhage.

Cited by 233 publications

References 24 publications

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

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

Venous thromboembolism occurs infrequently in meningioma patients receiving combined modality prophylaxis

Venous Thromboembolism in Brain Tumor Patients: A Review of Literature

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