Intermittend pneumatic venous thrombembolism (VTE) prophylaxis during neurosurgical procedures.
Humans
Neurosurgical Procedures
/ methods
Venous Thromboembolism
/ prevention & control
Female
Male
Middle Aged
Intermittent Pneumatic Compression Devices
Aged
Adult
Postoperative Complications
/ prevention & control
Retrospective Studies
Elective Surgical Procedures
/ methods
Anticoagulants
/ therapeutic use
Risk Factors
Deep venous thrombosis
Intermittend pneumatic compression
Neurosurgery
Pulmonary embolism
Venous thromboembolism
Journal
Acta neurochirurgica
ISSN: 0942-0940
Titre abrégé: Acta Neurochir (Wien)
Pays: Austria
ID NLM: 0151000
Informations de publication
Date de publication:
14 Jun 2024
14 Jun 2024
Historique:
received:
19
03
2024
accepted:
14
05
2024
medline:
14
6
2024
pubmed:
14
6
2024
entrez:
14
6
2024
Statut:
epublish
Résumé
The management of perioperative venous thrombembolism (VTE) prophylaxis is highly variable between neurosurgical departments and general guidelines are missing. The main issue in debate are the dose and initiation time of pharmacologic VTE prevention to balance the risk of VTE-based morbidity and potentially life-threatening bleeding. Mechanical VTE prophylaxis with intermittend pneumatic compression (IPC), however, is established in only a few neurosurgical hospitals, and its efficacy has not yet been demonstrated. The objective of the present study was to analyze the risk of VTE before and after the implementation of IPC devices during elective neurosurgical procedures. All elective surgeries performed at our neurosurgical department between 01/2018-08/2022 were investigated regarding the occurrence of VTE. The VTE risk and associated mortality were compared between groups: (1) only chemoprophylaxis (CHEMO; surgeries 01/2018-04/2020) and (2) IPC and chemoprophylaxis (IPC; surgeries 04/2020-08/2022). Furthermore, general patient and disease characteristics as well as duration of hospitalization were evaluated and compared to the VTE risk. VTE occurred after 38 elective procedures among > 12.000 surgeries. The number of VTEs significantly differed between groups with an incidence of 31/6663 (0.47%) in the CHEMO group and 7/6688 (0.1%) events in the IPC group. In both groups, patients with malignant brain tumors represented the largest proportion of patients, while VTEs in benign tumors occurred only in the CHEMO group. The use of combined mechanical and pharmacologic VTE prophylaxis can significantly reduce the risk of postoperative thromboembolism after neurosurgical procedures and, therefore, reduce mortality and morbidity.
Sections du résumé
BACKGROUND
BACKGROUND
The management of perioperative venous thrombembolism (VTE) prophylaxis is highly variable between neurosurgical departments and general guidelines are missing. The main issue in debate are the dose and initiation time of pharmacologic VTE prevention to balance the risk of VTE-based morbidity and potentially life-threatening bleeding. Mechanical VTE prophylaxis with intermittend pneumatic compression (IPC), however, is established in only a few neurosurgical hospitals, and its efficacy has not yet been demonstrated. The objective of the present study was to analyze the risk of VTE before and after the implementation of IPC devices during elective neurosurgical procedures.
METHODS
METHODS
All elective surgeries performed at our neurosurgical department between 01/2018-08/2022 were investigated regarding the occurrence of VTE. The VTE risk and associated mortality were compared between groups: (1) only chemoprophylaxis (CHEMO; surgeries 01/2018-04/2020) and (2) IPC and chemoprophylaxis (IPC; surgeries 04/2020-08/2022). Furthermore, general patient and disease characteristics as well as duration of hospitalization were evaluated and compared to the VTE risk.
RESULTS
RESULTS
VTE occurred after 38 elective procedures among > 12.000 surgeries. The number of VTEs significantly differed between groups with an incidence of 31/6663 (0.47%) in the CHEMO group and 7/6688 (0.1%) events in the IPC group. In both groups, patients with malignant brain tumors represented the largest proportion of patients, while VTEs in benign tumors occurred only in the CHEMO group.
CONCLUSION
CONCLUSIONS
The use of combined mechanical and pharmacologic VTE prophylaxis can significantly reduce the risk of postoperative thromboembolism after neurosurgical procedures and, therefore, reduce mortality and morbidity.
Identifiants
pubmed: 38874608
doi: 10.1007/s00701-024-06129-4
pii: 10.1007/s00701-024-06129-4
doi:
Substances chimiques
Anticoagulants
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
264Informations de copyright
© 2024. The Author(s).
Références
Adeeb N, Hattab T, Savardekar A, Jumah F, Griessenauer CJ, Musmar B, Adeeb A, Trosclair K, Guthikonda B (2021) Venous thromboembolism prophylaxis in elective neurosurgery: A Survey of board-certified neurosurgeons in the United States and updated literature review. World Neurosurg 150:e631–e638
doi: 10.1016/j.wneu.2021.03.072
pubmed: 33757886
Afshari A, Fenger-Eriksen C, Monreal M, Verhamme P (2018) European guidelines on perioperative venous thromboembolism prophylaxis. Eur J Anaesthesiol 35(2):112–115
doi: 10.1097/EJA.0000000000000726
pubmed: 29112550
Algattas H, Damania D, DeAndrea-Lazarus I, Kimmell KT, Marko NF, Walter KA, Vates GE, Jahromi BS (2018) Systematic review of safety and cost-effectiveness of venous thromboembolism prophylaxis strategies in patients undergoing craniotomy for brain tumor. Neurosurgery 82(2):142–154
doi: 10.1093/neuros/nyx156
pubmed: 28402497
Colditz GA, Tuden RL, Oster G (1986) Rates of venous thrombosis after general surgery: Combined results of randomised clinical trials. Lancet 328(8499):143–146
doi: 10.1016/S0140-6736(86)91955-0
Collen JF, Jackson JL, Shorr AF, Moores LK (2008) Prevention of venous thromboembolism in neurosurgery: A metaanalysis. Chest 134(2):237–249
doi: 10.1378/chest.08-0023
pubmed: 18641095
Danish SF, Burnett MG, Stein SC (2004) Prophylaxis for deep venous thrombosis in patients with craniotomies: a review. Neurosurg Focus. https://doi.org/10.3171/foc.2004.17.4.2
doi: 10.3171/foc.2004.17.4.2
pubmed: 15633988
Dekkers OM, Horváth-Puhó E, Jørgensen JOL, Cannegieter SC, Ehrenstein V, Vandenbroucke JP, Pereira AM, Srøensen HT (2013) Multisystem morbidity and mortality in cushing’s syndrome: A cohort study. J Clin Endocrinol Metab 98(6):2277–2284
doi: 10.1210/jc.2012-3582
pubmed: 23533241
Dennis M (2013) Effectiveness of intermittent pneumatic compression in reduction of risk of deep vein thrombosis in patients who have had a stroke (CLOTS 3): A multicentre randomised controlled trial. Lancet 382(9891):516–524
doi: 10.1016/S0140-6736(13)61050-8
pubmed: 23727163
Ganau M, Prisco L, Cebula H, Todeschi J, Abid H, Ligarotti G, Pop R, Proust F, Chibbaro S (2017) Risk of Deep vein thrombosis in neurosurgery: State of the art on prophylaxis protocols and best clinical practices. J Clin Neurosci 45:60–66
doi: 10.1016/j.jocn.2017.08.008
pubmed: 28890040
Guo F, Shashikiran T, Chen X, Yang L, Liu X, Song L (2015) Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients. J Neurosci Rural Pract 6(4):471–476
doi: 10.4103/0976-3147.169801
pubmed: 26752303
pmcid: 4692000
Haas S, Encke A, Kopp I (2016) S3-Leitlinie zur Prophylaxe der venösen Thromboembolie: Neues und Bewährtes. Dtsch Medizinische Wochenschrift 141(7):453–456
doi: 10.1055/s-0042-100484
Heesen M, Kemkes-Matthes B, Deinsberger W, Boldt J, Matthes KJ (1997) Coagulation alterations in patients undergoing elective craniotomy. Surg Neurol 47(1):35–38
doi: 10.1016/S0090-3019(96)00388-6
pubmed: 8986163
Henwood PC, Kennedy TM, Thomson L, Galanis T, Tzanis GL, Merli GJ, Kraft WK (2011) The incidence of deep vein thrombosis detected by routine surveillance ultrasound in neurosurgery patients receiving dual modality prophylaxis. J Thromb Thrombolysis 32(2):209–214
doi: 10.1007/s11239-011-0583-8
pubmed: 21505787
Kakkos S, Kirkilesis G, Caprini JA, Geroulakos G, Nicolaides A, Stansby G, Reddy DJ (2022) Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005258.pub4
doi: 10.1002/14651858.CD005258.pub4
pubmed: 35089599
pmcid: 8796751
Khaldi A, Helo N, Schneck MJ, Origitano TC (2011) Venous thromboembolism: Deep venous thrombosis and pulmonary embolism in a neurosurgical population: Clinical article. J Neurosurg 114(1):40–46
doi: 10.3171/2010.8.JNS10332
pubmed: 20815694
Khorana AA, Francis CW, Culakova E, Kuderer NM, Lyman GH (2007) Thromboembolism is a leading cause of death in cancer patients receiving outpatient chemotherapy [10]. J Thromb Haemost 5(3):632–634
doi: 10.1111/j.1538-7836.2007.02374.x
pubmed: 17319909
Kimmell KT, Jahromi BS (2015) Clinical factors associated with venous thromboembolism risk in patients undergoing craniotomy. J Neurosurg 122(5):1004–1011
doi: 10.3171/2014.10.JNS14632
pubmed: 25495743
Kohro S, Yamakage M, Sato K, Sato JI, Namiki A (2005) Intermittent pneumatic foot compression can activate blood fibrinolysis without changes in blood coagulability and platelet activation. Acta Anaesthesiol Scand 49(5):660–664
doi: 10.1111/j.1399-6576.2005.00661.x
pubmed: 15836680
Kohro S, Yamakage M, Takahashi T, Kondo M, Ota K, Namiki A (2002) Intermittent pneumatic compression prevents venous stasis in the lower extremities in the lithotomy position. Can J Anesth 49(2):144–147
doi: 10.1007/BF03020486
pubmed: 11823391
Lyman GH, Kessler CM (2012) The incidence of venous thromboembolism in cancer patients: A real-world analysis. Clin Adv Hematol Oncol 10(1):40–42
pubmed: 22398806
Nunno A, Li Y, Pieters TA, Towner JE, Schmidt T, Shi M, Walter K, Li YM (2019) Risk factors and associated complications of symptomatic venous thromboembolism in patients with craniotomy for meningioma. World Neurosurg 122:e1505–e1510
doi: 10.1016/j.wneu.2018.11.091
pubmed: 30468929
O’Donnell M, Weitz JI (2003) Thromboprophylaxis in surgical patients. Can J Surg 46(2):129–135
pubmed: 12691354
pmcid: 3211697
Pranata R, Deka H, Yonas E, Vania R, Tondas AE, Lukito AA, July J (2020) The use of intermittent pneumatic compression to prevent venous thromboembolism in neurosurgical patients—A systematic review and meta-analysis. Clin Neurol Neurosurg. https://doi.org/10.1016/j.clineuro.2020.105694
doi: 10.1016/j.clineuro.2020.105694
pubmed: 32006929
Prell J, Schenk G, Taute BM, Scheller C, Marquart C, Strauss C, Rampp S (2019) Reduced risk of venous thromboembolism with the use of intermittent pneumatic compression after craniotomy: A randomized controlled prospective study. J Neurosurg 130(2):622–628
doi: 10.3171/2017.9.JNS17533
Raabe A, Gerlach R, Zimmermann M, Seifert V (2000) Praxis der thromboseprophylaxe in der neurochirurgie: Ergebnisse einer umfrage in deutschland. Zentralbl Neurochir 61(2):103–110
doi: 10.1055/s-2000-8267
pubmed: 10986759
Rachinger JC, Koman G, Scheller C, Prell J, Rampp S, Strauss C (2011) Practice in the perioperative prevention of deep vein thrombosis in german neurosurgical departments is there a trend towards homogenization? Zentralbl Neurochir 72(3):115–119
doi: 10.1055/s-0031-1280791
Rethinasamy R, Alias A, Kandasamy R, Raffiq A, Looi MC, Hillda T (2019) Deep vein thrombosis and the neurosurgical patient. Malaysian J Med Sci 26(5):139–147
doi: 10.21315/mjms2019.26.5.13
Rizzo SM, Tavakol S, Bi WL, Li S, Secemsky EA, Campia U, Piazza G, Goldhaber SZ, Schmaier AA (2023) Meningioma resection and venous thromboembolism incidence, management, and outcomes. Res Pract Thromb Haemost 7(2):100121
doi: 10.1016/j.rpth.2023.100121
pubmed: 37063769
pmcid: 10099298
Rolston JD, Han SJ, Bloch O, Parsa AT (2014) What clinical factors predict the incidence of deep venous thrombosis and pulmonary embolism in neurosurgical patients? J Neurosurg 121(4):908–918
doi: 10.3171/2014.6.JNS131419
pubmed: 25084467
Schwahn-Schreiber C, Breu FX, Rabe E, Buschmann I, Döller W, Lulay GR, Miller A, Valesky E, Reich-Schupke S (2018) S1-Leitlinie Intermittierende Pneumatische Kompression (IPK, AIK). Der Hautarzt. https://doi.org/10.1007/s00105-018-4219-1
Shaikhouni A, Baum J, Lonser RR (2018) Deep Vein thrombosis prophylaxis in the neurosurgical patient. Neurosurg Clin N Am 29(4):567–574
doi: 10.1016/j.nec.2018.06.010
pubmed: 30223969
Stephens H, Healy MT, Smith M, Jewkes PDA (1995) Prophylaxis against thromboembolism in neurosurgical patients: A survey of Current practice in the United kingdom. Br J Neurosurg 9(2):159–164
doi: 10.1080/02688699550041494
pubmed: 7632361
Su Z-J, Wang H-R, Liu L-Q, Li N, Hong X-Y (2023) Analysis of risk factors for postoperative deep vein thrombosis after craniotomy and nomogram model construction. World J Clin Cases 11(31):7543–7552
doi: 10.12998/wjcc.v11.i31.7543
pubmed: 38078121
pmcid: 10698453
White RH, Zhou H, Romano PS (2003) Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 90(3):446–455
pubmed: 12958614
Zhang Z, Cai H, Vleggeert-Lankamp CLA (2023) Thromboembolic prophylaxis in neurosurgical practice: a systematic review. Acta Neurochir (Wien) 165(11):3119–3135
doi: 10.1007/s00701-023-05792-3
pubmed: 37796296
(2010) Recommendations | Venous thromboembolism in over 16s: reducing the risk of hospital-acquired deep vein thrombosis or pulmonary embolism | Guidance | NICE