The role of preoperative deep vein thrombosis screening in neurooncology

Abstract

OBJECTIVE Venous thromboembolism (VTE) is a major cause of morbidity in patients undergoing neurosurgical intervention. The authors postulate that the introduction of a routine preoperative deep vein thrombosis (DVT) screening protocol for patients undergoing neurosurgical intervention for brain tumors would result in a more effective diagnosis of DVT in this high-risk subgroup, and subsequent appropriate management of the condition would reduce pulmonary embolism (PE) rates and improve patient outcomes. METHODS The authors conducted a prospective study of 115 adult patients who were undergoing surgical intervention for a brain tumor. All patients underwent preoperative lower-limb Doppler ultrasonography scanning for DVT screening. Patients with confirmed DVT underwent a period of anticoagulation therapy, which was stopped prior to surgery. An inferior vena cava (IVC) filter was inserted to cover the perioperative period during which anticoagulation therapy was avoided due to bleeding risk before restarting the therapy at a later date. Patients underwent follow-up performed by a neurooncology multidisciplinary team, and subsequent complications and outcomes were recorded. RESULTS Seven (6%) of the 115 screened patients had DVT. Of these patients, one developed postoperative PE, and another had bilateral DVT postoperatively. None of the patients without preoperative DVT developed VTE postoperatively. Age, symptoms of DVT, and previous history of VTE were significantly higher in the group with preoperative DVT. There were no deaths and no complications from the anticoagulation or IVC filter insertion. CONCLUSIONS Preoperative screening for DVT is a worthwhile endeavor in patients undergoing neurosurgical intervention. A multidisciplinary approach in management of anticoagulation and IVC filter insertion is safe and can minimize further VTE in such patients.

Preventive Effect of Intensive Nursing Intervention of Deep Vein Thrombosis of Lower Extremities in Elderly Patients with Gastrointestinal Tumors after Surgery

“…VTE (venous thromboembolism) is the leading cause of morbidity in patients undergoing neurosurgical procedures, according to [ 19 ]. If a preoperative DVT screening protocol is implemented for patients having brain tumor surgery, the authors believe that this high-risk subgroup will be better identified as having DVT so that appropriate treatment can be given to minimize their risk of pulmonary embolism (PE) and improve their overall outcomes and quality of care.…”

Preanesthetic Evaluation and Preparation for Neurosurgical Procedures: An Indian Perspective

“…11 Preoperative DVT screening protocol helps in reducing pulmonary embolism rates and improving patient outcomes in the neurosurgical population. 12 However, currently, there are no recommendations for preoperative DVT screening in this population. Our survey response depicts that most respondents are not considering preoperative DVT screening.…”

“…18 Incidence of moderate to severe anemia (hematocrit < 30%) in elective cranial surgery is around 2.7%. 12 Preoperative anemia in the neurosurgical population can be multifactorial and results in poor outcome, prolonged hospitalization, and excessive resource utilization. 19 20 It should be detected and corrected before elective surgery.…”

Early Detection and Management of Venous Thrombosis in Skull Base Surgery: Role of Routine Doppler Ultrasound Monitoring

“…An alternative strategy reported in the literature for patients who can safely tolerate delay of surgery might be considered for therapeutic anticoagulation. 26…”