Venous thromboembolic events in patients undergoing craniotomy for tumor resection: incidence, predictors, and review of literature

Abstract

OBJECTIVEThe authors sought to investigate the incidence and predictors of venous thromboembolic events (VTEs) after craniotomy for tumor resection, which are not well established, and the efficacy of and risks associated with VTE chemoprophylaxis, which remains controversial.METHODSThe authors investigated the incidence of VTEs in a consecutive series of patients presenting to the authors’ institution for resection of an intracranial lesion between 2012 and 2017. Information on patient and tumor characteristics was collected and independent predictors of VTEs were determined using stepwise multivariate logistic regression analysis. Review of the literature was performed by searching MEDLINE using the keywords “venous thromboembolism,” “deep venous thrombosis,” “pulmonary embolism,” “craniotomy,” and “brain neoplasms.”RESULTSThere were 1622 patients included for analysis. A small majority of patients were female (52.6%) and the mean age of the cohort was 52.9 years (SD 15.8 years). A majority of intracranial lesions were intraaxial (59.3%). The incidence of VTEs was 3.0% and the rates of deep venous thromboses and pulmonary emboli were 2.3% and 0.9%, respectively. On multivariate analysis, increasing patient age (unit OR 1.02, 95% CI 1.00–1.05; p = 0.018), history of VTE (OR 7.26, 95% CI 3.24–16.27; p < 0.001), presence of motor deficit (OR 2.64, 95% CI 1.43–4.88; p = 0.002), postoperative intracranial hemorrhage (OR 4.35, 95% CI 1.51–12.55; p < 0.001), and prolonged intubation or reintubation (OR 3.27, 95% CI 1.28–8.32; p < 0.001) were independently associated with increased odds of a VTE. There were 192 patients who received VTE chemoprophylaxis (11.8%); the mean postoperative day of chemoprophylaxis initiation was 4.6 (SD 3.8). The incidence of VTEs was higher in patients receiving chemoprophylaxis than in patients not receiving chemoprophylaxis (8.3% vs 2.2%; p < 0.001). There were 30 instances of clinically significant postoperative hemorrhage (1.9%), with only 1 hemorrhage occurring after initiation of VTE chemoprophylaxis (0.1%).CONCLUSIONSThe study results show the incidence and predictors of VTEs after craniotomy for tumor resection in this patient population. The incidence of VTE within this cohort appears low and comparable to that observed in other institutional series, despite the lack of routine prophylactic anticoagulation in the postoperative setting.

Strategies for the Prevention of Complications in Brain Glioma Surgery

“…Venous thromboembolism, including deep venous thrombosis (DVT), and pulmonary embolism, often complicate the post-operative course of brain glioma patients 20 , primarily due to their prolonged immobility. Regardless of the lack of routine prophylactic anticoagulation therapy in the post-operative setting of patients in our series, the incidence of DVT was low (Table 3), and comparable to that observed in other institutional series 21 .…”

microRNAs and Markers of Neutrophil Activation as Predictors of Early Incidental Post-Surgical Pulmonary Embolism in Patients with Intracranial Tumors

“…The poor prognosis and the increase in disease burden related to VTE in cancer patients urges the need for the elaboration of risk stratification models to identify those patients at the highest risk to suffer VTE [27]. Despite the use of thromboprophylaxis in glioma and meningioma patients, a subgroup still develops post-surgical PE [2,3]. This clearly indicates that standard thromboprophylaxis is not adequate for all patients and those at a higher thrombotic risk are in need of a tailored dose and/or duration.…”

“…Accordingly, high-grade brain tumors correlate with a higher rate of VTE, including both deep vein thrombosis and pulmonary embolism (PE), being glioma one of the most thrombogenic among intracranial tumors [2]. The frequency of VTE after brain surgery is further increased [3]. However, it is different in malignant brain tumors such as glioma than in benign tumors such as meningioma, where operated patients have a risk of VTE up to 26% [4] and 30% [5,6], respectively.…”

Venous Thromboembolism Prophylaxis: Safe, but Still Provocative?

“…Expectedly, risk factors for VTE development included poor Karnofsky Performance Scale, motor deficits, and prior VTE, among other factors. 8 Other centers have reported similar rates of VTE but with routine use of subcutaneous heparin. 9 It is very likely that the rates of VTE would be reduced further if maximal mechanical means of prevention were combined with proven pharmacologic means.…”