title: Perioperative thromboprophylaxis in patients with craniotomy for brain tumours: a systematic review.
abstract: Venous thromboembolism (VTE) events are frequent in neurooncological patients in perioperative period thus increasing mortality and morbidity. The role of prophylaxis has not yet been established with certainty, and in various neurosurgery and intensive care units the practice is inconsistent. A better definition of the risk/cost/benefit ratio of the various methods, both mechanical (intermittent pneumatic compression-IPC, graduated compression stockings-GCS) and pharmacological (unfractionated heparin-UFH or low molecular weight heparin-LMWH), is warranted. We aim to define the optimal prophylactic treatment in the perioperative period in neurooncological patients. A systematic review of the literature was performed in Medline, Embase and Cochrane Library. Thirteen randomized controlled trials (RCTs) were identified, in which physical methods (IPC or GCS) and/or drugs (UFH or LMWHs) were evaluated in perioperative prophylaxis of neurological patients, mostly with brain cancer not treated with anticoagulants for other diseases. The analysis was conducted on a total of 1,932 randomized patients of whom 1,558 had brain tumours. Overall data show a trend of reduction of VTE in patients treated with mechanical methods (IPC or GCS) that should be initiated preoperatively and continued until discharge or longer in case of persistence of risk factors. The addition of enoxaparin starting the day after surgery, significantly reduces clinically manifest VTE, despite an increase in major bleeding events. Further studies are needed to delineate the types of patients with an increase of VTE risk and risk/benefits ratio of physical and pharmacological treatments in the perioperative period.
authors.affiliation: Unit of Clinical Neuro Oncology, Neuro Oncology Department, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy. a.salmaggi@ospedale.lecco.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Salmaggi
authors.forename: Giorgia
authors.initials: G
authors.lastname: Simonetti
authors.forename: Elisa
authors.initials: E
authors.lastname: Trevisan
authors.forename: Deirdre
authors.initials: D
authors.lastname: Beecher
authors.forename: Carmine Maria
authors.initials: CM
authors.lastname: Carapella
authors.forename: Francesco
authors.initials: F
authors.lastname: DiMeco
authors.forename: Laura
authors.initials: L
authors.lastname: Conti
authors.forename: Andrea
authors.initials: A
authors.lastname: Pace
authors.forename: Graziella
authors.initials: G
authors.lastname: Filippini
mesh_terms: D001932:Brain Neoplasms / Q000601:surgery / Q000628:therapy*; D003399:Craniotomy; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D054556:Venous Thromboembolism / Q000517:prevention & control*
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