Direct oral anticoagulants for therapeutic anticoagulation in postoperative pulmonary embolism after meningioma resection.
Adult
Anticoagulants
/ administration & dosage
Blood Coagulation
/ drug effects
Female
Follow-Up Studies
Humans
Male
Meningeal Neoplasms
/ diagnosis
Meningioma
/ diagnosis
Middle Aged
Neurosurgical Procedures
/ adverse effects
Postoperative Complications
/ diagnosis
Pulmonary Embolism
/ drug therapy
Retrospective Studies
Antithrombotic agents
Direct oral anticoagulation
Low-molecular-weight heparin
Pulmonary embolism
Journal
Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
ISSN: 1532-2653
Titre abrégé: J Clin Neurosci
Pays: Scotland
ID NLM: 9433352
Informations de publication
Date de publication:
Nov 2020
Nov 2020
Historique:
received:
29
08
2020
accepted:
28
09
2020
entrez:
23
11
2020
pubmed:
24
11
2020
medline:
9
2
2021
Statut:
ppublish
Résumé
Acute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored. This is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated. Of 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes. DOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.
Sections du résumé
BACKGROUND
BACKGROUND
Acute postoperative pulmonary embolism (PE) is a dreaded complication with severe mortality rates. Brain tumor patients are at the highest risk for postoperative PE. The juxtaposition of low-molecular-weight heparin (LMWH), vitamin K antagonists (VKA) and direct oral anticoagulation (DOAC) in the treatment of postoperative PE in meningioma patients is largely unexplored.
PATIENTS/METHODS
METHODS
This is a single center observational analysis of meningioma patients who underwent neurosurgical resection with a thoracic CT scan confirmation of postoperative PE. The treatment modality, clinical course and outcome were investigated.
RESULTS
RESULTS
Of 538 meningioma patients operated, 30 (6%) developed acute postoperative PE. After diagnosis, these patients received different long-term anticoagulation regimes. No significant difference in postoperative hemorrhage (p < 0.56), re-operation rate (p < 0.70) or Karnofsky performance scale (KPS) at 3 (p < 0.34) and 12 months (p = 1) were identified, when compared according to the different anticoagulation regimes.
CONCLUSION
CONCLUSIONS
DOACs were not associated with elevated risk for hemorrhage, recurrent thrombosis or poor outcome when compared with traditional anticoagulation regimes. Prospective randomized trials are necessary to verify the non-inferiority of DOACs for long-term anticoagulation in postoperative pulmonary embolism after meningioma resection.
Identifiants
pubmed: 33222927
pii: S0967-5868(20)31538-1
doi: 10.1016/j.jocn.2020.09.059
pii:
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
265-269Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.