title: Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is the most frequent complication following craniotomy for brain tumors. At Brigham and Women's Hospital, VTE after craniotomy for brain tumor is the leading cause of deep vein thrombosis (DVT) and pulmonary embolism (PE) among patients hospitalized for conditions other than VTE.
  
  
  OBJECTIVE
  To minimize VTE among patients undergoing craniotomy for brain tumor.
  
  
  METHODS
  Randomized, prospective, double-blind clinical trial.
  
  
  METHODS
  Brigham and Women's Hospital.
  
  
  METHODS
  One hundred fifty patients undergoing craniotomy for brain tumor randomized to enoxaparin, 40 mg/d, vs heparin, 5,000 U bid, with all patients receiving graduated compression stockings and intermittent pneumatic compression.
  
  
  METHODS
  The rate of DVT detected by venous ultrasonography prior to hospital discharge.
  
  
  RESULTS
  Symptomatic DVT or PE developed in none of the patients. The overall rate of asymptomatic VTE was 9.3%, with no significant difference in the rates between the two prophylaxis groups. Ten of the 14 patients identified with VTE had thrombus limited to the deep veins of the calf.
  
  
  CONCLUSIONS
  Enoxaparin, 40 mg/d, or unfractionated heparin, 5,000 U bid, in combination with graduated compression stockings, intermittent pneumatic compression, and predischarge surveillance venous ultrasonography of the legs, resulted in 150 consecutive patients without symptomatic VTE. The low 9.3% frequency of asymptomatic VTE comprised mostly isolated calf DVT. Therefore, this comprehensive, multimodality approach to VTE prophylaxis achieved excellent efficacy and safety.
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. sgoldhaber@partners.org
authors.forename: Samuel Z
authors.initials: SZ
authors.lastname: Goldhaber
authors.forename: Kelly
authors.initials: K
authors.lastname: Dunn
authors.forename: Marie
authors.initials: M
authors.lastname: Gerhard-Herman
authors.forename: John K
authors.initials: JK
authors.lastname: Park
authors.forename: Peter McL
authors.initials: PM
authors.lastname: Black
mesh_terms: D001458:Bandages; D001932:Brain Neoplasms / Q000601:surgery*; D003131:Combined Modality Therapy; D003399:Craniotomy; D004311:Double-Blind Method; D017984:Enoxaparin / Q000008:administration & dosage; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005676:Gravity Suits; D006493:Heparin / Q000008:administration & dosage; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D013923:Thromboembolism / Q000209:etiology / Q000517:prevention & control*
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin