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

Abstract

OBJECTIVE The term "venous thromboembolism" (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism. The incidence of DVT after craniotomy was reported to be as high as 50%. Even clinically silent DVT may lead to potentially fatal pulmonary embolism. The risk of VTE is correlated with duration of surgery, and it appears likely that it develops during surgery. The present study aimed to evaluate intraoperative use of intermittent pneumatic compression (IPC) of the lower extremity for prevention of VTE in patients undergoing craniotomy. METHODS A total of 108 patients undergoing elective craniotomy for intracranial pathology were included in a single-center controlled randomized prospective study. In the control group, conventional compression stockings were worn during surgery. In the treatment group, IPC of the calves was used in addition. The presence of DVT was evaluated by Doppler sonography pre- and postoperatively. RESULTS Intraoperative use of IPC led to a significant reduction of VTE (p = 0.029). In logistic regression analysis, the risk of VTE was approximately quartered by the use of IPC. Duration of surgery was confirmed to be correlated with VTE incidence (p < 0.01); every hour of surgery increased the risk by a factor of 1.56. CONCLUSIONS Intraoperative use of IPC significantly lowers the incidence of potentially fatal VTE in patients undergoing craniotomy. The method is easy to use and carries no additional risks. ■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class I. Clinical trial registration no.: DRKS00011783 ( https://www.drks.de ).

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

“…Interestingly, this study found no increase in hemorrhage due to continuous heparinization. Regarding the CLOTS trial [ 41 ], our management rules did not provide for IPC, although other sources found it to be useful in a strictly neurosurgical collective in an RCT [ 42 ]. We will therefore consider the additional use of IPC in future treatment.…”

Effects and safety of intraoperative intermittent pneumatic compression for preventing postoperative venous thromboembolism: a meta-analysis

“…Among them, 28 reports were excluded with failure to meet the inclusion criteria. Finally, a total of 13 studies [15][16][17][18][19][20][21][22][23][24][25][26][27] including seven RCTs [15,16,21,22,[25][26][27] and six retrospective cohort studies [17-20, 23, 24] were included in this meta-analyses.…”

“…The characteristics and quality of included studies As presented in Table 1, of the included 13 studies [15][16][17][18][19][20][21][22][23][24][25][26][27] in this meta-analysis, a total of 6673 surgical patients were included, and 1883 patients underwent IPC intervention. The types of surgery included joint replacement, neurosurgery, intracranial surgery, breast surgery, gastrointestinal surgery, gynecological surgery in this meta-analysis.…”

“…The incidence of DVT in the included RCTs 7 RCTs [15,16,21,22,[25][26][27] reported the incidence of DVT, there was no significant heterogeneity (I 2 =40%, P=0.13) and fixed model was applied for meta-analysis. As presented in Figure 2, the synthesize outcome indicated that IPC was beneficial to the reduce the incidence of DVT (RR0.30, 95%CI0.22~0.40, P<0.001).…”

Research quality in the study of mechanical methods of deep vein thrombosis prophylaxis

“…The practical advantage of this approach has made it more a common design for recent trials. [33][34][35][36][37][38] A new method can be added to the existing prophylactic regime of a patient group without exposure to increased DVT risk. However, care must be taken to ensure that the possible results of the trial would have unambiguous clinical meanings.…”