title: Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors.
abstract: OBJECTIVE
  The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs.
  
  
  METHODS
  All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor.
  
  
  RESULTS
  Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1·040; 95% confidence interval (CI), 1·026-1·052; P<0·0001], high grade glioma (OR, 1·702; 95% CI, 1·176-2·465; P = 0·005), older age (OR, 1·033; 95% CI, 1·020-1·046; P<0·0001), hypertension (OR, 1·785; 95% CI, 1·180-2·699; P = 0·006), and motor deficit (OR, 1·854; 95% CI, 1·244-2·763; P = 0·002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage.
  
  
  CONCLUSIONS
  The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.
authors: Johns Hopkins University School of Medicine, Department of Neurosurgery, Baltimore, MD, USA. kaisorn@jhmi.edu
authors: Kaisorn L
authors: KL
authors: Chaichana
authors: Courtney
authors: C
authors: Pendleton
authors: Christopher
authors: C
authors: Jackson
authors: Juan Carlos
authors: JC
authors: Martinez-Gutierrez
authors: Andrea
authors: A
authors: Diaz-Stransky
authors: Javier
authors: J
authors: Aguayo
authors: Alessandro
authors: A
authors: Olivi
authors: Jon
authors: J
authors: Weingart
authors: Gary
authors: G
authors: Gallia
authors: Michael
authors: M
authors: Lim
authors: Henry
authors: H
authors: Brem
authors: Alfredo
authors: A
authors: Quinones-Hinojosa
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D001932:Brain Neoplasms / Q000150:complications / Q000601:surgery*; D003399:Craniotomy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012307:Risk Factors; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*
chemical_list: D000925:Anticoagulants