Hemostasis activation in patients undergoing brain tumor surgery

Abstract

Patients undergoing brain tumor surgery are at high risk for the occurrence of a thromboembolic event. To identify a laboratory marker suitable for risk estimation the authors studied the perioperative time pattern of routine coagulation parameters and the specific hemostasis activation marker D-dimer in 28 consecutive patients at high risk (11 patients with glioma and eight patients with meningioma) and low risk (nine patients with metastases) for thromboembolism, as previously reported. As is typical during major surgery, most of the routine parameters declined, probably because of hemodilution, and recovered postoperatively to values higher than baseline, probably because of an acute-phase reaction. On Days 2 and 7 after surgery no difference in the routine parameters was recorded between patients at high (meningioma and glioma) and low risk (metastasis). The level of D-dimer was elevated at baseline in patients with metastasis, indicating a hemostatic hyperactivity that is usual in cancer patients. During surgery a marked increase in D-dimer levels occurred in patients with meningioma and glioma (pre- and postoperative median 90/2000 and 100/1020 ng/ml, respectively), but the increase was less pronounced in patients with metastasis (320/660 ng/ml). Postoperatively, D-dimer declined in patients with metastases to lower than preoperative levels (Day 7, 270 ng/ml); in patients with meningioma or glioma, however, D-dimer levels remained elevated until Day 7 (450 and 200 ng/ml, respectively). These results indicate that levels of D-dimer correlate with the reported high risk for thromboembolism in patients with meningioma and glioma, and D-dimer should be evaluated for its use in estimating individual risk and the efficiency of its use in the control of prophylactic treatment.

Reduced risk of venous thromboembolism with the use of intermittent pneumatic compression after craniotomy: a randomized controlled prospective study

“…Although it is known that malignant disease is associated with an increased risk of VTE, 27,28 brain surgery in itself seems to imply additional risks. 36 In neurosurgical patients, hypercoagulability may be attributed to manipulation of brain tissue, which contains high concentrations of thromboplastin. 18 According to Heesen et al, the plasma concentration of the thrombin-antithrombin III complex will reach its peak 3 hours after the beginning of surgery.…”

“…This is probably due to venous stasis in an immobilized patient in combination with the release of thrombogenic substances from cerebral parenchyma. 18,36 As a consequence, prevention of VTE would appear to be most efficient by intraoperative means.…”

Rehabilitation of persons with central nervous system tumors

“…Persons with brain tumors are at significant risk for deep venous thrombosis (DVT) and pulmonary embolism (PE) by virtue of their immobility, recent surgery, paresis, and hypercoagulable state 19, 24. The incidence of PE and DVT range up to 4% and 45%, respectively 25.…”

“…The incidence of PE and DVT range up to 4% and 45%, respectively 25. Those with metastatic disease may be at less risk 24, 25. Pharmacologic prophylaxis with low‐dose heparin for DVT and PE following neurosurgery, in general, appears to be relatively safe.…”

Some features controlling the blood D-dimer level after resection of malignant brain glioma

“…Рост уровня D-димера крови часто отмечается и у пациентов с опухолями головного мозга сразу после выполнения у них краниотомии [12], но только у 1 / 3 из них диагностируется венозный тромбоз и/или ТЭЛА [5,13]. Ряд авторов [14] отмечают, что одной из причин увеличения уровня D-димера без клиники венозного тромбоза является повреждение ткани мозга во время оперативного вмешательства, сопровождающееся выбросом тромбопластина.…”