Perioperative anticoagulation in patients with intracranial meningioma: No increased risk of intracranial hemorrhage?

Wilhelmy, Florian; Hantsche, Annika; Wende, Tim; Kasper, Johannes; Reuschel, Vera; Frydrychowicz, Clara; Rasche, Stefan; Lindner, Dirk; Meixensberger, Jürgen

doi:10.1371/journal.pone.0238387

Cited by 8 publications

(9 citation statements)

References 43 publications

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“…The need for informed consent was waived by the ethics committee of the University of Leipzig. Apart from the patient selection, methodology has been described before 8 , 11 , 12 . I confirm that all methods were performed in accordance with the relevant guidelines and regulations.…”

Section: Methodsmentioning

confidence: 99%

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Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Wilhelmy,

Gaier,

Planitzer

et al. 2023

Sci Rep

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In the perioperative management of patients with glioblastoma (GBM), physicians face the question of whether and when to administer prophylactic or therapeutic anticoagulation (AC). In this study, we investigate the effects of the timing of postoperative heparinization on thromboembolic events (TE) and postoperative hemorrhage (bleeding, PH) as well as the interactions between the two in the context of an underlying intracerebral malignancy. For this retrospective data analysis, 222 patients who underwent surgery for grade IV glioblastoma, IDH-wildtype (2016 CNS WHO) between 01/01/2014 and 31/12/2019 were included. We followed up for 12 months. We assessed various biographical and clinical data for risk factors and focused on the connection between timepoint of AC and adverse events. Subgroup analyses were performed for pulmonary artery embolism (PE), deep vein thrombosis, and postoperative intracranial hemorrhage (PH) that either required surgical intervention or was controlled radiologically only. Statistical analysis was performed using Mann–Whitney U-Test, Chi-square test, Fisher’s exact test and univariate binomial logistic regression. p values below 0.05 were considered statistically significant. There was no significant association between prophylactic AC within 24 h and more frequent major bleeding (p = 0.350). AC in patients who developed major bleeding was regularly postponed by the physician/surgeon upon detection of the re-bleeding; therefore, patients with PH were anticoagulated significantly later (p = 0.034). The timing of anticoagulant administration did not differ significantly between patients who experienced a thromboembolic event and those who did not (p = 0.634). There was considerable overlap between the groups. Three of the six patients (50%) with PE had to be lysed or therapeutically anticoagulated and thereafter developed major bleeding (p < 0.001). Patients who experienced TE were more likely to die during hospitalization than those with major bleeding (p = 0.022 vs. p = 1.00). Prophylactic AC within 24 h after surgery does not result in more frequent bleeding. Our data suggests that postoperative intracranial hemorrhage is not caused by prophylactic AC but rather is a surgical complication or the result of antithrombotic therapy. However, thromboembolic events worsen patient outcomes far more than postoperative bleeding. The fact that bleeding may occur as a complication of life-saving lysis therapy in the setting of a thromboembolic event should be included in this cost–benefit consideration.

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Section: Methodsmentioning

confidence: 99%

“…There are various studies on whether or not to apply chemoprophylaxis or mechanical devices such as intermittent pneumatic compression boots in patients with intracranial pathologies 9 , 10 . Yet, there is scarce data on when to apply said prophylaxis 11 , 12 .…”

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confidence: 99%

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Wilhelmy,

Gaier,

Planitzer

et al. 2023

Sci Rep

Self Cite

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“…Несмотря на противоречивость данных о безопасности применения антикоагулянтов, большинство авторов считает, что назначение НМГ оправданно ввиду их эффективности в профилактике ВТЭО [18,19]. Комбинированная профилактика позволяет предотвратить в среднем 91 случай ВТЭО на 1000 пациентов нейрохирургического профиля, при этом только у 7 из них могут развиться ВЧК [12].…”

Section: ранняя активизацияunclassified

Results of early administration of low molecular weight heparin for prevention of venous thromboembolism after removal of brain tumors

Бервицкий

Guzhin

Мойсак

et al. 2021

Nejrohirurgiâ (Mosk.)

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Introduction. Patients with brain tumors are at increased risk for the development of venous thromboembolism (VTE). The most effective prevention method today is a combination of mechanical compression of the lower extremities and the introduction of low molecular weight heparin (LMWH). In 2018, an algorithm for the prevention of VTE was introduced in our clinic, which implies the early (in the first 48 h after surgery) administration of LMWH.The study objective is to assess the effect of early LMWH administration on the incidence of intracranial hemorrhage (ICH) after removal of brain tumors.Materials and methods. From January 2014 to December 2019, 3266 patients underwent removal of brain tumors. The group 1 included 2057 patients who were treated in the period before the introduction of the VTE prevention algorithm (2014– 2017), the group 2 included 1209 patients who were treated using this algorithm (2018–2019). In each of the groups, the frequency and timing of ICH were assessed. The severity of complications was assessed according to the F.A.L. Ibanez classification. The data were compared between groups 1 and 2, as well as between patients who received LMWH at the time of ICH and those who did not receive.Results. Patients of the group 1 were prescribed LMWH in 14.3 % of cases, on average on the 4th day after surgery. In this group, 26 (1.26 %) patients developed ICH. Patients of the group 2 were prescribed LMWH in 89 % of cases, on average on the 2nd day. In this group, 15 (1.24 %) patients developed ICH. Severe complications were in 6 (85.7 %) of 7 patients who received LMWH at the time of ICH, and in 25 (73.5 %) of 34 patients who did not receive LMWH (p = 0.66).Conclusion. The widespread use of LMWH for the prevention of VTE during the first 48 h after removal of brain tumors did not lead to an increase in the frequency of ICH. At the same time, patients with ICH who developed during the use of LMWH often had a more severe clinical course.

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“…The fact that the expression of Ki-67 and p53 can only be determined by using surgical or biopsy specimens from tumors remains a challenge in clinical practice. However, these are invasive procedures and may increase the risk of bleeding and the possibility of tumor metastasis ( 6 , 7 ). Moreover, given that the evaluation of both markers relies on an expert pathologist’s decision, interobserver result variations are inevitable.…”

Section: Introductionmentioning

confidence: 99%

Preoperative prediction of Ki-67 and p53 status in meningioma using a multiparametric MRI-based clinical-radiomic model

et al. 2023

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PurposeTo investigate the utility of preoperative multiparametric magnetic resonance imaging (mpMRI)-based clinical-radiomic analysis combined with machine learning (ML) algorithms in predicting the expression of the Ki-67 proliferative index and p53 tumor suppressor protein in patients with meningioma.MethodsThis multicenter retrospective study included 483 and 93 patients from two centers. The Ki-67 index was classified into high (Ki-67≥5%) and low (Ki-67<5%)-expressed groups, and the p53 index was classified into positive (p53≥5%) and negative (p53<5%)-expressed groups. Clinical and radiological features were analyzed using univariate and multivariate statistical analyses. Six ML models were performed with different types of classifiers to predict Ki-67 and p53 status.ResultsIn the multivariate analysis, larger tumor volumes (p<0.001), irregular tumor margin (p<0.001), and unclear tumor-brain interface (p<0.001) were independently associated with a high Ki-67 status, whereas the presence of both necrosis (p=0.003) and the dural tail sign (p=0.026) were independently associated with a positive p53 status. A relatively better performance was yielded from the model constructed by combined clinical and radiological features. The area under the curve (AUC) and accuracy of high Ki-67 were 0.820 and 0.867 in the internal test, and 0.666 and 0.773 in the external test, respectively. Regarding p53 positivity, the AUC and accuracy were 0.858 and 0.857 in the internal test, and 0.684 and 0.718 in the external test.ConclusionThe present study developed clinical-radiomic ML models to non-invasively predict Ki-67 and p53 expression in meningioma using mpMRI features, and provides a novel non-invasive strategy for assessing cell proliferation.

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Perioperative anticoagulation in patients with intracranial meningioma: No increased risk of intracranial hemorrhage?

Cited by 8 publications

References 43 publications

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Results of early administration of low molecular weight heparin for prevention of venous thromboembolism after removal of brain tumors

Preoperative prediction of Ki-67 and p53 status in meningioma using a multiparametric MRI-based clinical-radiomic model

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