Advertisement

Journal of Neuro-Oncology

, Volume 113, Issue 2, pp 293–303 | Cite as

Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: a systematic review

  • Andrea SalmaggiEmail author
  • Giorgia Simonetti
  • Elisa Trevisan
  • Deirdre Beecher
  • Carmine Maria Carapella
  • Francesco DiMeco
  • Laura Conti
  • Andrea Pace
  • Graziella Filippini
Clinical Study

Abstract

Venous thromboembolism (VTE) events are frequent in neurooncological patients in perioperative period thus increasing mortality and morbidity. The role of prophylaxis has not yet been established with certainty, and in various neurosurgery and intensive care units the practice is inconsistent. A better definition of the risk/cost/benefit ratio of the various methods, both mechanical (intermittent pneumatic compression-IPC, graduated compression stockings-GCS) and pharmacological (unfractionated heparin-UFH or low molecular weight heparin-LMWH), is warranted. We aim to define the optimal prophylactic treatment in the perioperative period in neurooncological patients. A systematic review of the literature was performed in Medline, Embase and Cochrane Library. Thirteen randomized controlled trials (RCTs) were identified, in which physical methods (IPC or GCS) and/or drugs (UFH or LMWHs) were evaluated in perioperative prophylaxis of neurological patients, mostly with brain cancer not treated with anticoagulants for other diseases. The analysis was conducted on a total of 1,932 randomized patients of whom 1,558 had brain tumours. Overall data show a trend of reduction of VTE in patients treated with mechanical methods (IPC or GCS) that should be initiated preoperatively and continued until discharge or longer in case of persistence of risk factors. The addition of enoxaparin starting the day after surgery, significantly reduces clinically manifest VTE, despite an increase in major bleeding events. Further studies are needed to delineate the types of patients with an increase of VTE risk and risk/benefits ratio of physical and pharmacological treatments in the perioperative period.

Keywords

Brain tumours Thromboprophylaxis LMWH Intermittent pneumatic compression Graduated compression stockings 

Notes

Conflict of interest

We declare that we have no conflicts of interest.

References

  1. 1.
    Goldhaber SZ, Dunn K, Gerhard-Herman M, Park JK, Black PM (2002) Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis. Chest 122:1933–1937PubMedCrossRefGoogle Scholar
  2. 2.
    Dickinson LD, Miller LD, Patel CP, Gupta SK (1998) Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 43:1074–1081PubMedCrossRefGoogle Scholar
  3. 3.
    Cerrato D, Ariano C, Fiacchino F (1978) Deep vein thrombosis and low-dose heparin prophylaxis in neurosurgical patients. J Neurosurg 49:378–381PubMedCrossRefGoogle Scholar
  4. 4.
    Agnelli G, Piovella F, Buoncristiani P et al (1998) Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339:80–85PubMedCrossRefGoogle Scholar
  5. 5.
    Constantini S, Kanner A, Friedman A et al (2001) Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized, double-blind study. J Neurosurg 94:918–921PubMedCrossRefGoogle Scholar
  6. 6.
    Macdonald RL, Amidei C, Baron J et al (2003) Randomized, pilot study of intermittent pneumatic compression devices plus dalteparin versus intermittent pneumatic compression devices plus heparin for prevention of venous thromboembolism in patients undergoing craniotomy. Surg Neurol 59:363–372PubMedCrossRefGoogle Scholar
  7. 7.
    Auguste KI, Quinones-Hinojosa A, Berger MS (2004) Efficacy of mechanical prophylaxis for venous thromboembolism in patients with brain tumors. Neurosurg Focus 17:E3PubMedGoogle Scholar
  8. 8.
    Nurmohamed MT, van Riel AM, Henkens CM et al (1996) Low molecular weight heparin and compression stockings in the prevention of venous thromboembolism in neurosurgery. Thromb Haemost 75:233–238PubMedGoogle Scholar
  9. 9.
    Kakkar AK, Haas S, Wolf H, Encke A (2005) Evaluation of perioperative fatal pulmonary embolism and death in cancer surgical patients: the MC-4 cancer substudy. Thromb Haemost 94:867–871PubMedGoogle Scholar
  10. 10.
    Simanek R, Vormittag R, Hassler M et al (2007) Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol 9:89–95PubMedCrossRefGoogle Scholar
  11. 11.
    Agnelli G, Verso M (2007) Thromboprophylaxis during chemotherapy after advanced cancer. Thromb Res 120(Suppl 2):S128–S132PubMedCrossRefGoogle Scholar
  12. 12.
    Marras LC, Geerts WH, Perry JR (2000) The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 89:640–646PubMedCrossRefGoogle Scholar
  13. 13.
    Dennis M, Cranswick G (2010) Thigh-length versus below-knee stockings for deep venous thrombosis prophylaxis after stroke: a randomized trial. Ann Intern Med 153:553–562CrossRefGoogle Scholar
  14. 14.
    Higgins JPT, Altman DG (2009) Chapter 8: assessing risk of bias in included studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions, version 5.0.2. The cochrane collaboration. http://www.cochrane-handbook.org
  15. 15.
    DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7:177–188PubMedCrossRefGoogle Scholar
  16. 16.
  17. 17.
    Bucci MN, Papadopoulos SM, Chen JC et al (1989) Mechanical prophylaxis of venous thrombosis in patients undergoing craniotomy: a randomized trial. Surg Neurol 32:285–288PubMedCrossRefGoogle Scholar
  18. 18.
    Melon E, Keravel Y, Gaston A, Huet Y, Combes S (1991) Deep venous thrombosis prophylaxis by low molecular weight heparin in neurosurgical patients. [abstract]. Anesthesiology 75:A214CrossRefGoogle Scholar
  19. 19.
    Skillman JJ, Collins RE, Coe NP, Goldstein BS, Shapiro RM, Zervas NT, Bettmann MA, Salzman EW (1978) Prevention of deep vein thrombosis in neurosurgical patients: a controlled, randomized trial of external pneumatic compression boots. Surgery 83:354–358PubMedGoogle Scholar
  20. 20.
    Turpie AG, Gallus A, Beattie WS, Turpie HJ (1977) Prevention of venous thrombosis in patients with intracranial disease by intermittent pneumatic compression of the calf. Neurology 27:435–438PubMedCrossRefGoogle Scholar
  21. 21.
    Turpie AG, Hirsh J, Gent M, Julian D, Johnson J (1989) Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control. Arch Intern Med 149:679–681PubMedCrossRefGoogle Scholar
  22. 22.
    Wautrecht JC, Macquaire V, Vandesteene A et al (1996) Prevention of deep vein thrombosis in neurosurgical patients with brain tumors: a controlled, randomized study comparing graded compression stockings alone and with intermittent sequential compression: correlation with pre- and post-operative fibrinolysis; preliminary results. Int Angiol 15(suppl 1):5–10Google Scholar
  23. 23.
    Naccarato M, Grandi FC, Dennis M, Sandercock PA (2010) Physical methods for preventing deep vein thrombosis in stroke. Cochrane Database Syst Rev. (8):CD001922. doi: 10.1002/14651858.CD001922.pub3
  24. 24.
    CLOTS Trials Collaboration, Dennis M, Sandercock PA, Reid J, Graham C, Murray G, Venables G, Rudd A, Bowler G (2009) Effectiveness of thigh-length graduated compression stockings to reduce the risk of deep vein thrombosis after stroke (CLOTS trial 1): a multicentre, randomised controlled trial. Lancet 373:1958–1965PubMedCrossRefGoogle Scholar
  25. 25.
    Hamilton MG, Yee WH, Hull RD et al (2011) Venous thromboembolism prophylaxis in patients undergoing cranial neurosurgery: a systematic review and meta-analysis. Neurosurgery 68:571–581PubMedCrossRefGoogle Scholar
  26. 26.
    Treasure T, Hill J (2010) NICE guidance on reducing the risk of venous thromboembolism in patients admitted to hospital. J R Soc Med 103:210–212PubMedCrossRefGoogle Scholar
  27. 27.
    Guyatt GH, Norris SL, Schulman S, et al. (2012) American college of chest physicians. Methodology for the development of antithrombotic therapy and prevention of thrombosis guidelines: antithrombotic therapy and prevention of thrombosis, 9th edn: American college of chest physicians evidence-based clinical practice guidelines. Chest. 141(2 Suppl):53S–70S. doi: 10.1378/chest.11-2288

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Andrea Salmaggi
    • 1
    • 2
    Email author
  • Giorgia Simonetti
    • 1
  • Elisa Trevisan
    • 3
  • Deirdre Beecher
    • 4
  • Carmine Maria Carapella
    • 5
  • Francesco DiMeco
    • 6
    • 7
  • Laura Conti
    • 8
  • Andrea Pace
    • 9
  • Graziella Filippini
    • 4
  1. 1.Unit of Clinical Neuro Oncology, Neuro Oncology DepartmentFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
  2. 2.SC NeurologiaOspedale ManzoniLeccoItaly
  3. 3.Division of Neuro Oncology, Department of NeuroscienceUniversity and San Giovanni Battista HospitalTorinoItaly
  4. 4.Unit of NeuroepidemiologyFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
  5. 5.Division of Neurosurgery, Department of NeuroscienceRegina Elena National Cancer InstituteRomaItaly
  6. 6.Department of NeurosurgeryFondazione IRCCS Istituto Neurologico Carlo BestaMilanItaly
  7. 7.Department of Neurological SurgeryJohns Hopkins UniversityBaltimoreUSA
  8. 8.Clinical Pathology UnitRegina Elena National Cancer InstituteRomeItaly
  9. 9.Neurooncology UnitRegina Elena National Cancer InstituteRomeItaly

Personalised recommendations