The Risk of Postoperative Hemorrhage and Efficacy of Heparin for Preventing Deep Vein Thrombosis and Pulmonary Embolism in Adult Patients Undergoing Neurosurgery: A Systematic Review and Meta-Analysis

Abstract

The aim of this meta-analysis was to examine the risk of postoperative bleeding and efficacy of heparin for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in adult patients undergoing neurosurgery. MEDLINE, Cochrane, and EMBASE databases were searched until October 31, 2016, for randomized controlled trials (RCTs) and non-randomized comparative studies that assessed the rates of postoperative hemorrhage, DVT, PE, and mortality in adult patients undergoing neurosurgery. Nine eligible studies (five RCTs, four retrospective studies) including 874 patients treated with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and 1033 patients in control group (placebo with or without compression device) were analyzed. The overall analysis revealed that there was an increase in the risk of postoperative hemorrhage in patients who received heparin (pooled OR 1.66, 95% CI 1.01 to 2.72, p=0.046) compared with no treatment group. The risk of postoperative hemorrhage was more significant if only RCTs were included in analysis. Heparin prophylaxis was associated with a decrease in the risk of DVT (pooled OR 0.48, 95% CI 0.36 to 0.65, p<0.001) and PE (pooled OR 0.25, 95% CI 0.09 to 0.73, p=0.011) but it did not affect the rate of mortality. In conclusion, heparin increased the rate of postoperative bleeding, decreased the risk of DVT, PE and venous thromboembolic event (VTE) but it did not affect the mortality of patients undergoing neurosurgery. For the heparin prophylaxis, the trade-off between the risk of postoperative bleeding and benefit of prophylaxis against VTEs requires further investigation.

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

“…Similarly, we found data on prophylactic treatment in patients operated on for a high-grade glioma [31,32], as well as data for venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors [33] as well as prophylaxis in patients who had undergone decompressive craniectomy [34]. Wang et al elucidated the risk and benefits of heparin usage in adult patients receiving neurosurgery in a systematic review and meta-analysis [35]. However, there are no data on specific time points or comparisons of dosage when previous AC treatment is assessed.…”

Thromboembolic complications in neurosurgery: solutions at the boundaries of possible and necessary (review)

“…описали относительное снижение риска ВТЭО на 42 % при применении комбинированной профилактики [3]. Эти данные соотносятся с выводами и ряда других метаанализов и систематических обзоров, посвященных проблеме [17,[66][67][68].…”

“…В метаанализе X. Wang и соавт. сделан вывод о том, что применение антикоагулянтов снижает риск развития ВТЭО, но в то же время повышает риск геморрагических осложнений, тем не менее отмечено, что гепаринопрофилактика не оказывает влияния на общую летальность [67]. M. G. Hamilton и соавт.…”

Malignant middle cerebral artery infarct: A clinical case report

“…Current evidence supports combined mechanical and chemical thromboprophylaxis within 24 hours after surgery (Tsaousi et al, 2017). However, there is a higher risk of postoperative haemorrhage for patients who receive heparin (Wang et al, 2017). It is therefore important to monitor closely for signs of postoperative haemorrhage, particularly intracranial haemorrhage (ICH).…”