Natural History of Postoperative Deep-Vein Thrombosis

Vv, Kakkar; Howe, C. T.; Flanc, C; Clarke, Maxine

doi:10.1016/s0140-6736(69)90002-6

Cited by 844 publications

(276 citation statements)

References 8 publications

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“…Furthermore, thrombosis was demonstrated in 20 per cent of legs thought to be normal on clinical examination. Kakkar, Howe, Flanc, and Clarke (1969), using a radio-isotope technique, demonstrated this same point. I n addition, these workers, in a postoperative study on 132 patients, claimed that 40 developed thrombosis.…”

Section: Discussionmentioning

confidence: 65%

The early diagnosis of deep-vein thrombosis by ultrasound

Evans

1970

Journal of British Surgery

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Section: Discussionmentioning

confidence: 65%

The early diagnosis of deep-vein thrombosis by ultrasound

Evans

1970

Journal of British Surgery

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“…However, experimental data in rats suggest an increased risk of intracerebral hemorrhage if anticoagulation therapy is initiated during the first 7 postoperative days [24]. Placement of a vena cava umbrella, on the other hand, carries a low risk when properly performed, but it does not help reduce the occurrence or sequelae of lower extremity thrombophlebitis [23,25,26].…”

Section: Discussionmentioning

confidence: 99%

Postoperative venous thromboembolism and brain tumors: part I. Clinical profile

et al. 1992

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Forty-six patients who underwent surgery for brain tumors were studied prospectively with 125I labeled Fibrinogen leg scans to detect postoperative venous thrombosis. The incidence of thrombosis was 72% for meningioma patients, 60% for glioblastoma patients, and 20% for brain metastasis patients.Correlation between the occurrence of venous thrombosis and the various clinical factors thought to be responsible for the high incidence of thrombosis generally failed to show statistical significance. This finding, along with the marked variation in the incidence of venous thrombosis between the different brain tumor groups, strongly suggests that biological factors play a more important role than clinical factors in determining which brain tumor patient will suffer a postoperative thrombotic event.A direct association between malignancies and thromboembolic complications has been well established, but the occurrence of these complications in patients with brain tumors has not received sufficient attention. Wetzel et al. reviewed a series of 6,065 neurosurgical patients [1] and found a 3% incidence of fatal postoperative pulmonary emboli; however, patients with brain tumors were not specifically identified [1]. In an autopsy study involving 334 patients with primary intracranial neoplasms, the incidence of venous thrombosis was 27.5%, statistically significantly different from the 17% incidence for a control neurosurgical group [2]. Several clinical studies have confirmed a high incidence of postoperative thrombophlebitis in neurosurgical patients [3][4][5][6][7][8][9], but brain tumor patients have rarely been studied separately.In another study, Ruff & Posner reported [10] that of 268 consecutive patients with malignant glioma, 36% developed clinical signs of systemic venous thrombosis. Choucair et al. [11], in their series of 715 patients, identified a 4% risk of venous thromboembolism after 6 weeks of the craniotomy. In none of these studies were the patients evaluated prospectively.We undertook this study with the hope of specifically identifying clinical risk factors and reliably estimating the incidence of postoperative clots detectable by 125I-labeled fibrinogen scans in patients with the three most common brain tumors [12,13]. Materials and methodsForty-six male patients operated on for glioblastoma, meningioma, or brain metastasis at the V.A.M.C. in Cincinnati were included in this study. Clinical data obtained preoperatively included patient age, side of the lesion, duration of symptoms, Karnofsky score, ambulatory status, and the presence of paresis.

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“…25 Increasing proximal isotope activity may indicate propagating thrombosis (Fig 4) and should be an indica¬ tion for phlebography or technetium Tc 99m albumin ag¬ gregated clot localization studies. If results are con¬ firmatory, energetic anticoagulation therapy should be instituted.…”

Section: Resultsmentioning

confidence: 99%