Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: A Japanese single-center, retrospective study

Nakano, Fumi; Matsubara, Takehiro; Ishigaki, Tomoki; Hatazaki, Seiji; Mouri, Genshin; Nakatsuka, Yoshinari; Suzuki, Hitomi

doi:10.1016/j.thromres.2018.03.016

Cited by 18 publications

(30 citation statements)

References 34 publications

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“…Perhaps the most perplexing of all our results was the slight reduction in VTE risk associated with CNS surgery in the PHIS cohort. Surgical procedures are often associated with an increased risk of VTE, 43,44 including in pediatric patients. 10 Several studies in adults 37,41,45 and children 46 have shown little or no association between craniotomy and VTE.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database

Graham

Coven

Stanek

et al. 2020

Pediatric Blood & Cancer

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Background: Central nervous system (CNS) tumors are the second most common malignancy of childhood, and published data on venous thromboembolism (VTE) rate and risk factors for these patients are outdated or incomplete. Here, we determine the cumulative incidence and risk factors for VTE in this population. Procedure: VTE diagnosis and associated clinical risk factors were abstracted and analyzed for two cohorts of children (0-21 years) diagnosed with CNS tumors between January 1, 2010 to September 30, 2018. The first study was a retrospective single institution cohort study. The initial observations were confirmed across multiple pediatric hospitals using the Pediatric Health Information System (PHIS) administrative database. Results: The single-institution cohort included 338 patients aged 3 days to 20.9 years (median age, 8.6 years); VTE developed in eight (2.4%) patients. The PHIS cohort included 17 634 patients aged from 0 to 21.9 years (median: 9.5 years); VTE developed in 354 (2.0%) patients. Univariate analysis for the single-institution cohort identified central venous catheter (CVC) placement as a risk factor for VTE (odds ratio [OR] 8.40, 95% confidence interval [CI] 1.43-49.41, P = .0186). Multivariable analysis of the PHIS dataset identified CVC placement (OR 1.97, 95% CI 1.57-2.46; P < .0001), obesity (OR 2.96, 95% CI 1.21-7.26; P = .0177), and more than one hospital admission (OR 3.54, 95% CI 2.69-4.64; P < .0001) as significant predictors of VTE. VTE diagnosis was not associated with increased mortality in either cohort. Conclusions: The VTE rate in children with CNS tumors is low (2%). CVC placement was identified as a modifiable risk factor in both cohorts.

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Section: Discussionmentioning

confidence: 99%

Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database

Graham

Coven

Stanek

et al. 2020

Pediatric Blood & Cancer

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“…Frequency of DVT is reportedly between 2 to 21.3%. 1,2,3,4,13,14,15 In 102 acute ischemic stroke patients, 40% incidence of venous thromboembolism (VTE) at 21 days was noted. 16 Within fi rst month of stroke, risk of fatal pulmonary embolism (PE) is 1-2%.…”

Section: Discussionmentioning

confidence: 99%

“…Sample size of the cohort was calculated with power of 80% and 95% confi dence interval. Due to large variability in incidence of DVT in patient with neurosurgical diseases (ranging from 2 to 21.3%), 1,2,3,4 incidence reported for TBI i.e. 16.9% 3 was used as incidence in population.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…eep venous thrombosis (DVT) is known to occur in 2-8% of patients with spine injuries, 9.7% in Sub-arachnoid hemorrhages (SAH), 16.9% in traumatic brain injuries (TBI) and highest in brain tumours (21.3%). 1,2,3,4 Neurosurgical patients due to poor sensorium and weakness are often bed ridden exposing them to risk of DVT and consequent pulmonary embolism (PE). Without prophylaxis, incidence of DVT is estimated to be 60%.…”

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confidence: 99%

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WeMPiC protocol to prevent Deep Venous Thrombosis in patients with neurosurgical diseases

Thapa¹,

Kc²,

Shakya³

et al. 2020

Nep J Neurosci

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Background: Deep Venous Thrombosis is a common yet difficult problem to prevent in neurosurgical patients. Recent trials did not find sufficient evidence to support use of graduated compression stockings, however we believe, this inefficiency may be due to the method of application which needs to be modified. We have been following a patient specific mechanical prophylaxis protocol, nicknamed WeMPiC. This study aims to evaluate the effectiveness of WeMPiC protocol. Methods: An observational cohort study was performed including consecutive patients admitted to neurosurgical ICU who were bedridden for >7 days between April 2014 and September 2017. We developed WeMPiC protocol of early weaning off, early mobilization, limb physiotherapy and alternate two hours on and off application of thigh length graduated compression stockings. Lower limbs compression ultrasound studies were performed on alternate days. Results: One hundred thirty-one patients were included in the study. Mean age of patients was 53.7+ 20.6 years. Of these patients, 52.7% had stroke (91% had hemorrhages), 32.1% had head injury and 7.6% each had spine problem and brain tumor each. five (3.8%) developed deep venous thrombosis on the 4th and 6th day of ICU stay, mainly in popliteal veins (2.3%) and femoral veins (1.5%). Deep venous thrombosis was associated with younger age (47 years, p=0.005), ICU stay (13 days, p=0.014), Wells’ score (4.6, p<0.0001) and Poor Glasgow Coma Score at presentation (9, p=0.004). Power of study calculated for the cohort incidence of 3.8% was 100%. Cost benefit of $336 with WeMPiC protocol was seen as compared to the Low molecular weight heparin prophylaxis over four weeks. Conclusions: Compared to incidence of 12.1% in CLOTS 3 trial among the unexposed patients, we report a risk reduction of 8.3% with WeMPiC protocol which is cost effective and highly applicable in resource constraint scenarios.

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“…These types of operations are characterized by long operation time, a large amount of blood loss, need for blood transfusion, and the need to be performed under general anesthesia, and all of these parameters contribute to the risk of venous thrombosis formation 29,30 . At present, clinical researchers in different surgical specialties, including general surgery 31 , orthopedics 32 , thoracic surgery 33 , urology 34 , tumor surgery 35 and neurosurgery 36 , found that the incidence of VTE after major surgery is relatively high, ranging from 3.6% 31 to 21.3% 36 . They believe that major surgery is a risk factor for VTE and that active prevention is needed 8 .…”

Section: Discussionmentioning

confidence: 99%

Disease-Related Risk Factors for CVC-Related Symptomatic Thrombosis in Surgical ICU Inpatients

Liu

Zhu

Kuang

et al. 2020

Preprint

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To report the rate of symptomatic catheter-related venous thrombosis (CRVT) in surgical intensive care unit patients receiving central venous catheters (CVC) and analyze the disease-related risk factors for symptomatic CRVT in SICU patients. A retrospective analysis was performed on 1643 critically ill patients admitted to the SICU from January 2015 to December 2019. Cases were divided into two groups based on the presence of symptomatic CRVT, and the variables of interest were extracted from the electronic medical record system. Logistic univariate and multivariate regression analyses were used to determine the risk factors of SCRVT. A total of 209 symptomatic CRVT events occurred among 2114 catheters. Multivariate analysis showed that trauma (odds ratio [OR], 2.046; 95% confidence interval [CI] [1.325-3.160], P = 0.001), major surgery (OR, 2.457; 95% CI [1.641-3.679], P = 0.000), and heart failure (OR, 2.087; 95% CI [1.401-3.111], P = 0.000) were independent risk factors for symptomatic CRVT in SICU. The AUROC for this model was 0.610 (95% CI [0.569-0.651], P=0.000). The incidence rate was 9.89%. For patients hospitalized in the SICU, especially those admitted with these three conditions, thromboprophylaxis and/or mechanical prophylaxis should be actively provided to reduce the occurrence of symptomatic CRVT.

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Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: A Japanese single-center, retrospective study

Cited by 18 publications

References 34 publications

Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database

Venous thromboembolism in children with central nervous system tumors: Comparison of an institutional cohort to a national administrative database

WeMPiC protocol to prevent Deep Venous Thrombosis in patients with neurosurgical diseases

Disease-Related Risk Factors for CVC-Related Symptomatic Thrombosis in Surgical ICU Inpatients

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