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


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.


Brain tumours Thromboprophylaxis LMWH Intermittent pneumatic compression Graduated compression stockings 


Conflict of interest

We declare that we have no conflicts of interest.


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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

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