Systematic Review of Safety and Cost-Effectiveness of Venous Thromboembolism Prophylaxis Strategies in Patients Undergoing Craniotomy for Brain Tumor

Algattas, Hanna; Damania, Dushyant; DeAndrea-Lazarus, Ian A; Kimmell, Kristopher T.; Marko, Nicholas F.; Walter, Kevin A.; Vates, G. Edward; Jahromi, Babak S.

doi:10.1093/neuros/nyx156

Cited by 22 publications

(23 citation statements)

References 57 publications

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“…This is especially true in the US; in a contemporary review of VTE prophylaxis in neurosurgery, the authors state that IPC was used as the main means for mechanical VTE prophylaxis in all US centers that contributed data to the review. 2 However, in their conclusion they ultimately chose to recommend mechanical prophylaxis (along with unfractionated heparin) without further differentiation between IPC and compression stockings: as yet, there is no proven superiority of IPC over compression stockings in patients undergoing neurosurgery. 3 In the present study, such superiority has now been demonstrated by a controlled, prospective, and randomized single-center setup.…”

Section: Figmentioning

confidence: 99%

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

Prell¹,

Schenk²,

Taute³

et al. 2019

Journal of Neurosurgery

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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 ).

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Section: Figmentioning

confidence: 99%

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

Prell¹,

Schenk²,

Taute³

et al. 2019

Journal of Neurosurgery

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“…A lack of scientific evidence is primarily the cause of this variation in recommendations. Recent systematic reviews and meta-analyses of VTE prophylaxis in patients undergoing craniotomy for brain tumors have been performed [ 42 , 57 – 60 ]. These analyses have compared different VTE prophylaxis modalities, as well as their safety and cost effectiveness, but they do not thoroughly investigate the efficacy of prophylaxis over time to determine a recommended duration.…”

Section: Discussionmentioning

confidence: 99%

“…Many patients may not need or benefit from continuing thromboprophylactic therapy beyond discharge. Algattas et al reviewed the safety and effectiveness of thromboprophylactic strategies and indicated that different regimens may have different efficacies depending on the patient’s VTE risk profile [ 57 ]. This highlights the importance of using the appropriate risk profile for optimizing postoperative management.…”

Section: Discussionmentioning

confidence: 99%

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

et al. 2017

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Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005–2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).

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“…The reported incidence rates of DVT and PE among neurosurgical patients are 0-34% and 0-3.8%, respectively. Brain tumors are correlated with the increased risk of VTE and, among patients with brain tumors, the incidence rates of DVT and PE have been reported to be 24-30% and 0-5%, respectively [2,[4][5][6][7][8][9][10]. Chemoprophylaxis with low-molecular-weight heparin (LMWH) has been found to be the most efficacious method for VTE prevention when compared with unfractionated heparin (UFH) and mechanical prophylaxis (MP).…”

Section: Introductionmentioning

confidence: 99%

“…Chemoprophylaxis with low-molecular-weight heparin (LMWH) has been found to be the most efficacious method for VTE prevention when compared with unfractionated heparin (UFH) and mechanical prophylaxis (MP). However, this treatment comes with an increased risk of hemorrhage; the odds ratio for hemorrhage has been reported to be as high as 6.38 [95% confidence interval (CI): 0.58-69.91] when compared with placebo [4]. Postoperative hemorrhage following craniotomy, especially in the posterior fossa, can be catastrophic for patients [2,11].…”

Section: Introductionmentioning

confidence: 99%

Posterior Fossa Hemorrhage Following the Use of Low-Molecular-Weight Heparin: Lessons Learned and Recommendations for the Treatment and Prophylaxis of Postoperative Venous Thromboembolism

Naeem¹,

Bhargava²,

Bohl³

et al. 2021

Cureus

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IntroductionVenous thromboembolism (VTE) is the most common preventable cause of morbidity and mortality among neurosurgery patients. Several studies have concluded that the use of chemical prophylaxis among patients undergoing a craniotomy reduces the incidence of VTE, and it is presumed to be safe. However, these studies do not differentiate between a supratentorial and posterior fossa craniotomy. Furthermore, the prophylactic or therapeutic use of low-molecular-weight heparin (LMWH) has been reported to increase the risk of intracranial hemorrhage. In this study, we describe the clinical details and outcomes for all patients who underwent posterior fossa craniotomy and developed posterior fossa hemorrhage secondary to postoperative use of LMWH during the study period. We also propose recommendations pertaining to postoperative heparin use after posterior fossa surgeries. MethodsData were retrospectively collected for patients presenting with posterior fossa hemorrhage following anticoagulant use among those who previously underwent posterior fossa craniotomy by the senior author

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Systematic Review of Safety and Cost-Effectiveness of Venous Thromboembolism Prophylaxis Strategies in Patients Undergoing Craniotomy for Brain Tumor

Cited by 22 publications

References 57 publications

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

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

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

Posterior Fossa Hemorrhage Following the Use of Low-Molecular-Weight Heparin: Lessons Learned and Recommendations for the Treatment and Prophylaxis of Postoperative Venous Thromboembolism

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