Low rate of venous thromboembolism after craniotomy for brain tumor using multimodality prophylaxis.
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.
Goldhaber
Samuel Z
SZ
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. sgoldhaber@partners.org
Dunn
Kelly
K
Gerhard-Herman
Marie
M
Park
John K
JK
Black
Peter McL
PM
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*
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin