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Liu X, Zhang X, Ma T, Li M, Zhang L, Li S, Zeng M, Kass IS, Peng Y. Risk factors for postoperative thrombosis-related complications in patients undergoing malignant brain tumor resection: a retrospective cohort study. Front Neurol 2023; 14:1108596. [PMID: 37144008 PMCID: PMC10151791 DOI: 10.3389/fneur.2023.1108596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
Introduction Patients with malignant brain tumors frequently exhibit hypercoagulation and are at a high risk of postoperative thrombosis-related complications. However, the risk factors for postoperative thrombosis-related complications remain unclear. Methods In this retrospective, observational study, we consecutively enrolled elective patients undergoing resection of malignant brain tumors from 26 November 2018 to 30 September 2021. The primary objective of the study was to identify risk factors for a composite of three major adverse events including postoperative lower limb deep venous thrombosis, pulmonary embolism, and cerebral ischemia. Results A total of 456 patients were enrolled in this study, where 112 (24.6%) patients had postoperative thrombosis-related complications, 84 (18.4%) with lower limb deep venous thrombosis, 0 (0.0%) with pulmonary embolism, and 42 (9.2%) with cerebral ischemia. In a multivariate model, age more than 60 years (OR: 3.98, 95% CI: 2.30-6.88, P < 0.001), preoperative abnormal APTT (OR: 2.81, 95% CI: 1.06-7.42, P = 0.037), operation duration longer than 5 h (OR: 2.36, 95% CI: 1.34-4.16, P = 0.003), and admission to ICU (OR: 2.49, 95% CI: 1.21-5.12, P = 0.013) were independent risk factors of the postoperative deep vein thrombosis. Intraoperative plasma transfusion (OR: 6.85, 95% CI: 2.73-17.18, P < 0.001) was associated with significantly increased odds of deep vein thrombosis. Conclusion Patients with craniocerebral malignant tumors have a high incidence of postoperative thrombosis-related complications. There is an increase in the odds of postoperative lower limb deep venous thrombosis in patients; over 60 years old, with preoperative abnormal APTT, undergoing surgeries longer than 5-h, admission to ICU, or receiving intraoperative plasma infusion. Fresh frozen plasma infusion should be used more cautiously, especially in patients with a high risk of thrombosis.
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Affiliation(s)
- Xiaoyuan Liu
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xingyue Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tingting Ma
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Muhan Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Liyong Zhang
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Shu Li
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Min Zeng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ira S. Kass
- Anesthesiology and Physiology and Pharmacology Departments, State University of New York Downstate Health Sciences University, New York, NY, United States
| | - Yuming Peng
- Department of Anesthesiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yuming Peng
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Lubnin AY, Israelyan LA, Moshkin AV. [Hemostatic disorders in neurosurgical patients: diagnostics and correction]. ZHURNAL VOPROSY NEIROKHIRURGII IMENI N. N. BURDENKO 2023; 87:98-110. [PMID: 37011335 DOI: 10.17116/neiro20238702198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
The authors analyzed the main causes of perioperative hemostatic disorders in neurosurgical patients. The problem of preoperative hemostatic screening, intraoperative and postoperative factors contributing to hemostatic disorders are considered. The authors also discuss the methods for correction of hemostatic disorders.
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Affiliation(s)
- A Yu Lubnin
- Burdenko Neurosurgical Center, Moscow, Russia
| | | | - A V Moshkin
- Burdenko Neurosurgical Center, Moscow, Russia
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Lilly GL, Sweeny L, Santucci N, Cannady S, Frost A, Anagnos V, Curry J, Sagalow E, Freeman C, Puram SV, Pipkorn P, Slijepcevic A, Fuson A, Bonaventure C, Wax MK. Perioperative Hypercoagulability in Free Flap Reconstructions Performed for Intracranial Tumors. Laryngoscope 2022; 133:1103-1109. [PMID: 36196963 DOI: 10.1002/lary.30417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE(S) Patients with intracranial tumors have a higher risk of thromboembolic events. This risk increases at the time of surgical intervention. We have noted an anecdotal increase in perioperative flap thrombosis in patients undergoing free tissue transfer for intracranial tumor resection. This study aims to formally evaluate this risk. METHODS A multi-institutional retrospective chart review was performed of patients who underwent free tissue transfer for scalp/cranial reconstruction. Perioperative thrombosis and free flap outcomes were evaluated. RESULTS The 209 patients who underwent 246 free tissue transfers were included in the study. The 28 free flap scalp reconstructions were associated with intracranial tumors, 19 were performed following composite cranial resections with associated dural resection/reconstruction, and 199 were performed in the absence of intracranial tumors (control group). There was a significantly higher incidence of perioperative flap thrombosis in the intracranial tumor group (11/28, 39%) when compared to controls (38/199, 19%) (p = 0.0287). This was not seen when scalp tumors extended to the dura alone (4/19, 21%, p = 0.83). Therapeutic anticoagulation used for perioperative thrombosis (defined as intraoperative or in the immediate postoperative phase up to 5 days) was associated with a lower risk of flap failure, although this was not statistically significant (p = 0.148). Flap survival rates were equivalent between flaps performed for intracranial pathology (93.3%) and controls (95%). CONCLUSION There is an increase in perioperative flap thrombosis in patients with intracranial tumors undergoing free tissue scalp reconstruction. Anticoagulation appears to mitigate this risk. LEVEL OF EVIDENCE This recommendation is based on level 3 evidence (retrospective case-control studies, systematic review of retrospective studies, and case reports) Laryngoscope, 2022.
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Affiliation(s)
- Gabriela L Lilly
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Larissa Sweeny
- Department of Otolaryngology - Head and Neck Surgery, The University of Miami Health System, Miami, Florida, USA
| | - Nicole Santucci
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Steven Cannady
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ariel Frost
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Vincent Anagnos
- Department of Otolaryngology - Head and Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joseph Curry
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Emily Sagalow
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Cecilia Freeman
- Department of Otolaryngology - Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sidharth V Puram
- Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri, USA
| | - Patrik Pipkorn
- Department of Otolaryngology - Head and Neck Surgery, Washington University in St. Louis, St Louis, Missouri, USA
| | - Allison Slijepcevic
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
| | - Andrew Fuson
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Caroline Bonaventure
- Department of Otolaryngology - Head and Neck Surgery, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Mark K Wax
- Department of Otolaryngology - Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA
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Okamoto E, Ishikawa E, Kino H, Kohzuki H, Sugii N, Naito H, Hara T, Homma S, Matsuda M, Tsurubuchi T, Ishikawa T, Kawakami Y, Akutsu H. Perioperative Deep Vein Thrombosis and D-dimer Measurement in Patients with Brain Tumor. Neurol Med Chir (Tokyo) 2022; 62:186-194. [PMID: 35173104 PMCID: PMC9093672 DOI: 10.2176/jns-nmc.2021-0339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 12/22/2021] [Indexed: 11/20/2022] Open
Abstract
We investigated the appropriate D-dimer cutoff value for each brain tumor type for acute or subacute deep vein thrombosis (DVT) following transcranial brain tumor surgery.In this single-center retrospective study, a cumulative total of 128 patients who underwent transcranial brain tumor surgery were enrolled and classified into the glioma group, the other intracranial malignant tumor group, and the intracranial benign tumor group. Venous ultrasonography was performed if the D-dimer plasma levels were positive (≥1 μg/mL) before surgery and on postoperative day (POD) 3 or 7.Of the 128 cases, DVT developed in 32 (25.0%). Among those, acute or subacute DVT was diagnosed in 22 cases on POD 3 and in 8 cases on POD 7. Compared with DVT-negative cases on POD 3, acute or subacute DVT-positive cases on POD 3 revealed a significant increase in the D-dimer level in all groups combined and in the benign tumor group but not in the glioma group. With regard to DVT on POD 3 in all groups, the receiver operating characteristic curve for the D-dimer level on POD 3 demonstrated a cutoff value of 3.3 μg/mL (sensitivity [0.636] and specificity [0.750]). However, if this cutoff value was used in practice, eight cases would be false-negative with a minimum D-dimer level of 1.5 μg/mL.The D-dimer cutoff value for acute or subacute DVT on POD 3 could be set to 3.3 μg/mL; however, the setting resulted in several false-negative cases. Practically, 1.5 μg/mL of the D-dimer cutoff value on POD 3 might be appropriate to avoid false-negative results.
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Affiliation(s)
- Emiko Okamoto
- Graduate School of Comprehensive Human Sciences, University of Tsukuba
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
- Clinical Laboratory, University of Tsukuba Hospital
| | - Eiichi Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hiroyoshi Kino
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Hidehiro Kohzuki
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Narushi Sugii
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | | | - Takuma Hara
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Satoshi Homma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba
| | - Masahide Matsuda
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Takao Tsurubuchi
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Takaaki Ishikawa
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
| | - Yasushi Kawakami
- Department of Clinical Laboratory Medicine, Faculty of Medicine, University of Tsukuba
| | - Hiroyoshi Akutsu
- Department of Neurosurgery, Faculty of Medicine, University of Tsukuba
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Hu J, Geng Y, Ma J, Dong X, Fang S, Tian J. The Best Evidence for the Prevention and Management of Lower Extremity Deep Venous Thrombosis After Gynecological Malignant Tumor Surgery: A Systematic Review and Network Meta-Analysis. Front Surg 2022; 9:841275. [PMID: 35392060 PMCID: PMC8980406 DOI: 10.3389/fsurg.2022.841275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background: To search and obtain the relevant evidence of prevention and management of lower extremity deep venous thrombosis (DVT) after gynecological malignant tumor operation and to summarize the relevant evidence. Methods We searched the JBI evidence summary, up to date, the national comprehensive cancer network of the United States, the guide library of the National Institute of clinical medicine of the United Kingdom, PubMed, the Chinese biomedical literature database, CNKI, Wanfang, and other relevant evidence on the prevention and management of DVT in patients with gynecological malignant tumors. It includes clinical practice guidelines, best practice information book, expert consensus, evidence summary, original research, etc. The retrieval time limit is from database establishment till August 20, 2021. Two researchers independently evaluated the literature quality, combined with professional judgment, and extracted the literature that met the standards. Results Finally, 18 literatures were included, including eight guidelines, three evidence summaries, four systematic evaluations, two expert consensuses, and one best practice information volume. A total of 26 pieces of the best evidence on the prevention and management of postoperative venous thrombosis in gynecological malignant tumors were summarized. It includes risk assessment, drug prevention, mechanical prevention, management strategy, and health education. Conclusion This study summarized the best evidence of risk, prevention, and health management of DVT in postoperative patients with gynecological malignant tumors to provide evidence-based basis for clinical nurses and to improve the nursing level.
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Affiliation(s)
- Jiaqi Hu
- College of Nursing, Chengde Medical University, Chengde, China
| | - Yidan Geng
- College of Nursing, Chengde Medical University, Chengde, China
| | - Jingyi Ma
- College of Nursing, Chengde Medical University, Chengde, China
| | - Xuefan Dong
- College of Nursing, Chengde Medical University, Chengde, China
| | - Shuqin Fang
- Department of Gynecology, Affiliated Hospital of Chengde Medical University, Chengde, China
| | - Jianli Tian
- College of Nursing, Chengde Medical University, Chengde, China
- *Correspondence: Jianli Tian
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Wu J, Zhang W, Chen J, Fei H, Zhu H, Xie H. Application of and Clinical Research on Enhanced Recovery After Surgery in Perioperative Care of Patients With Supratentorial Tumors. Front Oncol 2021; 11:697699. [PMID: 34262874 PMCID: PMC8273649 DOI: 10.3389/fonc.2021.697699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 05/31/2021] [Indexed: 01/24/2023] Open
Abstract
PURPOSE This study intends to explore the safety and effectiveness of the concept of enhanced recovery after surgery (ERAS) in the perioperative care of patients with supratentorial tumors. METHODS A total of 151 supratentorial tumor patients were enrolled in this study, and they were divided into control group (n = 75) and observation group (n = 76) according to the random number table method. Patients in the control group received routine neurosurgery care, and patients in the observation group received enhanced recovery after surgery care. The incidence of perioperative complications, postoperative hospital stays, early postoperative eating time, catheter removal time, and time to get out of bed were observed for the two groups of patients, and the quality of postoperative recovery was evaluated. RESULTS There was no statistically significant difference in the basic data of the two groups of patients, such as age, gender, lesion location, and condition (P>0.05), and they were comparable. The observation group's postoperative eating time, catheter removal time, and time to get out of bed were significantly earlier than those of the control group. Postoperative hospital stays and hospitalization expenses were less than those of the control group. There was a statistically significant difference in postoperative hospital stay between the two groups (P<0.05). CONCLUSION Applying the ERAS concept to implement perioperative care for patients with supratentorial tumors is safe and effective. It can not only reduce after-surgical stress and accelerate postoperative recovery, but also shorten hospital stays and reduce hospital costs. It is worthy of clinical application.
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Affiliation(s)
- Jingmi Wu
- Department of Neurology, Ningbo First Hospital, Ningbo, China
| | - Weina Zhang
- Department of Neurology, Ningbo First Hospital, Ningbo, China
| | - Jie Chen
- Department of Neurology, Ningbo First Hospital, Ningbo, China
| | - Hui Fei
- Department of Theater, Ningbo First Hospital, Ningbo, China
| | - Hong Zhu
- Department of Theater, Ningbo First Hospital, Ningbo, China
| | - Haofen Xie
- Department of Nursing, Ningbo First Hospital, Ningbo, China
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7
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Bell JS, Florence TJ, Phillips HW, Patel K, Macaluso NJ, Villanueva PG, Naik PK, Kim W. Comparison of the Safety of Prophylactic Anticoagulants After Intracranial Surgery. Neurosurgery 2021; 89:527-536. [PMID: 34161594 DOI: 10.1093/neuros/nyab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 04/29/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Venous thromboembolism (VTE) represents a rare but preventable postoperative complication. Unfractionated heparin (UH) and low-molecular-weight heparin (LMWH) are used to prevent VTE, but comparative studies of their safety and efficacy in the neurosurgical context are limited. OBJECTIVE To determine the relative safety and efficacy of UH and LMWH for prophylaxis after cranial surgery. METHODS We performed a retrospective analysis of 3204 elective intracranial surgical admissions in 2901 patients over the period 2013 to 2018. From chart review, we extracted demographic and clinical features, including diagnosis and procedure, drugs administered, and the occurrence of VTE events. To compare postoperative outcomes, we performed propensity score matching of patients receiving different drugs, and reviewed postoperative cranial imaging. To contextualize our results, we selected 14 prior neurosurgical studies of VTE prophylaxis to compare our outcomes to the existing literature. RESULTS In our sample of 3204 admissions, the overall rate of VTE was 0.8% (n = 27). Rates of VTE were not statistically different in matched cohorts receiving UH and LMWH (1.7% vs 1.0%, respectively); however, LMWH was associated with a higher rate of clinically significant intracranial hemorrhage (ICH) (3.4% vs 0.5%, P = .008). Literature review and meta-analysis supported these findings. Across studies, UH and LMWH were associated with similar rates of VTE. Studies in which patients received LMWH reported significantly higher rates of ICH (4.9% higher, P = .005). CONCLUSION We find that LMWH and UH show similar efficacy in preventing VTE; however, LMWH is associated with higher rates of ICH.
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Affiliation(s)
- Joseph S Bell
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - T J Florence
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - H Westley Phillips
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Kunal Patel
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicholas J Macaluso
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Paulina G Villanueva
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Priyanka K Naik
- David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
| | - Won Kim
- Department of Neurosurgery, University of California, Los Angeles, Los Angeles, California, USA
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Shi S, Cheng J, Chen H, Zhang Y, Zhao Y, Wang B. Preoperative and intraoperative predictors of deep venous thrombosis in adult patients undergoing craniotomy for brain tumors: A Chinese single-center, retrospective study. Thromb Res 2020; 196:245-250. [PMID: 32919179 DOI: 10.1016/j.thromres.2020.09.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Brain tumor resection by craniotomy is associated with a high risk of deep vein thrombosis (DVT). This study evaluated the incidence and preoperative and intraoperative risk factors for DVT within 30 days of surgery. METHODS The analysis included: 1) basic clinical variables (patient age, sex, body mass index [BMI], tumor location, and tumor histology); 2) blood test results before operation, such as leukocytes, platelets, and coagulation parameters; and 3) surgical factors (total amount of blood lost, anesthesia mode, and surgery duration). RESULTS Of the 1670 patients, 206 (12.34%) had DVT and nine (0.54%) had both DVT and pulmonary embolism (PE) after surgery. Preoperative and intraoperative factors independently associated with DVT/PE were: older age 46-55 years (odds ratio [OR]: 2.87; 95% confidence interval [CI]: 1.83-4.50; P < 0.001), age 56-65 years (OR: 5.24; 95% CI: 3.27-8.40; P < 0.001), age > 65 years (OR: 6.00; 95% CI: 3.45-10.45; P < 0.001), BMI (OR: 1.03; 95% CI: 1.00-1.05; P = 0.029), activated partial thromboplastin time [APTT] (OR: 0.91; 95% CI: 0.86-0.95; P = 0.000), D-dimer (OR: 1.69; 95% CI: 1.23-2.34; P = 0.001), high-grade glioma (OR: 2.09; 95% CI: 1.28-3.40; P = 0.003), glio-neuronal (OR: 3.30; 95% CI: 1.28-8.47; P = 0.013), craniopharyngioma (OR: 2.16; 95% CI: 1.13-4.10; P = 0.019), and surgery duration (OR: 1.82; 95% CI: 1.27-2.60; P = 0.001). CONCLUSIONS Older age, BMI, preoperative APTT, D-dimer, tumor histology, and surgery duration independently increased the risk of developing postoperative DVT/PE. These findings provide prognostic information that will guide therapies aimed at minimizing the development of DVT/PE during hospitalization.
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Affiliation(s)
- Shuhai Shi
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Jingli Cheng
- Department of Neurosurgery, First Affiliated Hospital of Baotou Medical College, 014010 Baotou, Inner Mongolia Autonomous Region, China
| | - Haoliang Chen
- Department of Medical Information, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Yunxin Zhang
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Ying Zhao
- Department of Critical Care Medicine, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China
| | - Baoguo Wang
- Department of Anesthesiology, Sanbo Brain Hospital, Capital Medical University, 100093 Beijing, China.
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Rinaldo L, Brown DA, Bhargav AG, Rusheen AE, Naylor RM, Gilder HE, Monie DD, Youssef SJ, Parney IF. Venous thromboembolic events in patients undergoing craniotomy for tumor resection: incidence, predictors, and review of literature. J Neurosurg 2020; 132:10-21. [PMID: 30611138 PMCID: PMC6609511 DOI: 10.3171/2018.7.jns181175] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/24/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The 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. METHODS The 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." RESULTS There 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%). CONCLUSIONS The 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.
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Affiliation(s)
- Lorenzo Rinaldo
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Desmond A. Brown
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Adip G. Bhargav
- Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Aaron E. Rusheen
- Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | - Ryan M. Naylor
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hannah E. Gilder
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dileep D. Monie
- Medical Scientist Training Program, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota
| | | | - Ian F. Parney
- Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota
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Karsy M, Azab MA, Harper J, Abou-Al-Shaar H, Guan J, Eli I, Brock AA, Ormond RD, Hosokawa PW, Gouripeddi R, Butcher R, Cole CD, Menacho ST, Couldwell WT. Evaluation of a D-Dimer Protocol for Detection of Venous Thromboembolism. World Neurosurg 2019; 133:e774-e783. [PMID: 31605841 DOI: 10.1016/j.wneu.2019.09.160] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of venous duplex ultrasonography (VDU) for confirmation of deep venous thrombosis in neurosurgical patients is costly and requires experienced personnel. We evaluated a protocol using D-dimer levels to screen for venous thromboembolism (VTE), defined as deep venous thrombosis and asymptomatic pulmonary embolism. METHODS We used a retrospective bioinformatics analysis to identify neurosurgical inpatients who had undergone a protocol assessing the serum D-dimer levels and had undergone a VDU study to evaluate for the presence of VTE from March 2008 through July 2017. The clinical risk factors and D-dimer levels were evaluated for the prediction of VTE. RESULTS In the 1918 patient encounters identified, the overall VTE detection rate was 28.7%. Using a receiver operating characteristic curve, an area under the curve of 0.58 was identified for all D-dimer values (P = 0.0001). A D-dimer level of ≥2.5 μg/mL on admission conferred a 30% greater relative risk of VTE (sensitivity, 0.43; specificity, 0.67; positive predictive value, 0.27; negative predictive value, 0.8). A D-dimer value of ≥3.5 μg/mL during hospitalization yielded a 28% greater relative risk of VTE (sensitivity, 0.73; specificity, 0.32; positive predictive value, 0.24; negative predictive value, 0.81). Multivariable logistic regression showed that age, male sex, length of stay, tumor or other neurological disease diagnosis, and D-dimer level ≥3.5 μg/mL during hospitalization were independent predictors of VTE. CONCLUSIONS The D-dimer protocol was beneficial in identifying VTE in a heterogeneous group of neurosurgical patients by prompting VDU evaluation for patients with a D-dimer values of ≥3.5 μg/mL during hospitalization. Refinement of this screening model is necessary to improve the identification of VTE in a practical and cost-effective manner.
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Affiliation(s)
- Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Mohammed A Azab
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Jonathan Harper
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Hussam Abou-Al-Shaar
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA; Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York, USA
| | - Jian Guan
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ilyas Eli
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Andrea A Brock
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - Ryan D Ormond
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA
| | - Patrick W Hosokawa
- Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Aurora, Colorado, USA
| | | | - Ryan Butcher
- Department of Bioinformatics, University of Utah, Salt Lake City, Utah, USA
| | - Chad D Cole
- Department of Neurosurgery, New York Medical College, Valhalla, New York, USA
| | - Sarah T Menacho
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA
| | - William T Couldwell
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
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