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Göteborgs universitets publikationer

Venous thromboembolism prophylaxis in meningioma surgery - a population based comparative effectiveness study of routine mechanical prophylaxis with or without preoperative low molecular weight heparin

Författare och institution:
Kristin Sjåvik (-); Jiri Bartek jr. (-); Ole Solheim (-); Tor Ingebrigtsen (-); Sasha Gulati (-); Lisa M. Sagberg (-); Petter Förander (-); Asgeir Store Jakola (Institutionen för neurovetenskap och fysiologi, sektionen för klinisk neurovetenskap och rehabilitering)
Publicerad i:
World Neurosurgery, 88 s. 320–326
ISSN:
1878-8750
E-ISSN:
1878-8769
Publikationstyp:
Artikel, refereegranskad vetenskaplig
Publiceringsår:
2016
Språk:
engelska
Fulltextlänk:
Sammanfattning (abstract):
Object: Venous thromboembolism (VTE) is a serious complication after intracranial meningioma surgery. To what extent systemic prophylaxis with pharmacotherapy is beneficial with respect to VTE risk, or associated with increased risk of bleeding and postoperative hemorrhage, remains debated. The current study aimed to clarify the risk-benefit of prophylactic pharmacotherapy initiated the evening before craniotomy for meningioma. METHODS: In a Scandinavian population-based cohort we conducted a retrospective review of 979 operations for intracranial meningioma between 2007 and 2013 at three neurosurgical centers with population-based referral. We compared two different treatment strategies analyzing frequencies of VTE and proportions of postoperative intracranial hematomas requiring surgery or intensified subsequent observation or care (ICU or other intensified observation and/or treatment). One neurosurgical center favored preoperative prophylaxis with low-molecular weight heparin (LMWH) ("LMWH routine group") in addition to mechanical prophylaxis, while two centers favored mechanical prophylaxis with LMWH only given as needed in cases of delayed mobilization ("LMWH as needed group"). RESULTS: In the LMWH routine group, VTE was diagnosed after 24/626 operations (3.9%), while VTE was diagnosed after 11/353 (3.1%) operations in the LMWH as needed group (p=0.56). Clinically relevant postoperative hematomas occurred after 57/626 operations (9.1%) in the LMWH routine group compared to 23/353 (6.5%) in the LMWH as needed group (p=0.16). Surgically evacuated postoperative hematomas occurred after 19/626 operations (3.0%) in the LMWH routine group compared to 8/353 operations (2.3%) in the LMWH as needed group (p=0.26). CONCLUSION: There is no benefit of routine preoperative LMWH starting before intracranial meningioma surgery. Neither could we for primary outcomes detect a significant increase in clinically relevant postoperative hematomas secondary to this regimen. We suggest that "as-needed" perioperative administration of LMWH, reserved for patients with excess risk due to delayed mobilization, is effective and also appears to be the safest strategy.
Ämne (baseras på Högskoleverkets indelning av forskningsämnen):
MEDICIN OCH HÄLSOVETENSKAP ->
Klinisk medicin
MEDICIN OCH HÄLSOVETENSKAP ->
Klinisk medicin ->
Cancer och onkologi
MEDICIN OCH HÄLSOVETENSKAP ->
Klinisk medicin ->
Kirurgi ->
Neurokirurgi
Nyckelord:
Anticoagulants; Low-molecular-weight heparin; Meningioma; Neurosurgery; Postoperative hemorrhage; Venous thromboembolism
Postens nummer:
234378
Posten skapad:
2016-04-07 17:28
Posten ändrad:
2016-05-30 15:47

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