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

Andrea Salmaggi, Giorgia Simonetti, Elisa Trevisan, Deirdre Beecher, Carmine Maria Carapella, Francesco Dimeco, Laura Conti, Andrea Pace, Graziella Filippini

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)293-303
Number of pages11
JournalJournal of Neuro-Oncology
Volume113
Issue number2
DOIs
StatePublished - Jun 2013

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Craniotomy
Brain Neoplasms
Venous Thromboembolism
Perioperative Period
Low Molecular Weight Heparin
Pharmacology
Compression Stockings
Enoxaparin
Neurosurgery
Ambulatory Surgical Procedures
Anticoagulants
Libraries
Cost-Benefit Analysis
Intensive Care Units
Heparin
Randomized Controlled Trials
Odds Ratio
Hemorrhage
Morbidity
Mortality

Keywords

  • Brain tumours
  • Graduated compression stockings
  • Intermittent pneumatic compression
  • LMWH
  • Thromboprophylaxis

ASJC Scopus subject areas

  • Clinical Neurology
  • Cancer Research
  • Oncology
  • Neurology
  • Medicine(all)

Cite this

Salmaggi, A., Simonetti, G., Trevisan, E., Beecher, D., Carapella, C. M., Dimeco, F., ... Filippini, G. (2013). Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: A systematic review. Journal of Neuro-Oncology, 113(2), 293-303. https://doi.org/10.1007/s11060-013-1115-5

Perioperative thromboprophylaxis in patients with craniotomy for brain tumours : A systematic review. / Salmaggi, Andrea; Simonetti, Giorgia; Trevisan, Elisa; Beecher, Deirdre; Carapella, Carmine Maria; Dimeco, Francesco; Conti, Laura; Pace, Andrea; Filippini, Graziella.

In: Journal of Neuro-Oncology, Vol. 113, No. 2, 06.2013, p. 293-303.

Research output: Contribution to journalArticle

Salmaggi, A, Simonetti, G, Trevisan, E, Beecher, D, Carapella, CM, Dimeco, F, Conti, L, Pace, A & Filippini, G 2013, 'Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: A systematic review', Journal of Neuro-Oncology, vol. 113, no. 2, pp. 293-303. https://doi.org/10.1007/s11060-013-1115-5
Salmaggi, Andrea ; Simonetti, Giorgia ; Trevisan, Elisa ; Beecher, Deirdre ; Carapella, Carmine Maria ; Dimeco, Francesco ; Conti, Laura ; Pace, Andrea ; Filippini, Graziella. / Perioperative thromboprophylaxis in patients with craniotomy for brain tumours : A systematic review. In: Journal of Neuro-Oncology. 2013 ; Vol. 113, No. 2. pp. 293-303.
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