title: Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery.
abstract: OBJECTIVE
  Brain tumors may be associated with postoperative venous thromboembolic (VTE) events with possible devastating consequences. Meningioma has the highest incidence of postoperative VTE events among all brain tumors. Hemodilution and anticoagulation both proved efficacy in deep venous thrombosis (DVT) prophylaxis that is why we theorized that this regimen would be beneficial for VTE prophylaxis in operated intracranial meningioma patients without added risk to the patients.
  
  
  METHODS
  A retrospective double-blinded study, where the records of consecutive intracranial meningioma patients were revised comparing the efficacy of two regimens of postoperative VTE prophylaxis. Patients were divided into 2 groups; group A was submitted to the use of compressive stockings, low-molecular weight heparin (LMWH) administration and hemodilution, while group B was submitted only to the use of compressive stockings.
  
  
  RESULTS
  The study included 194 patients. Mean age of patients was 55 years (range from 27 to 78 years). VTE events were diagnosed in 16 patients (8.2%) all of them belonged to group B. The median time for VTE events was 12 days. Older age (P=.0001), larger size tumor (p=0.0438), delayed ambulation postoperatively (p=0.0351) as well as skull base location of meningioma (p=0.0163) were associated with higher incidence of postoperative VTE. Overall, group A patients showed more favorable outcome as compared to group B.
  
  
  CONCLUSIONS
  In addition to the use of elastic stockings, we recommend starting hemodilution at the outset of surgery, LMWH administration starting 12h postoperatively as well as refraining from the use of diuretics during and after intracranial meningioma surgery till the patient became fully ambulatory to reduce the incidence of postoperative VTE events.
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt. Electronic address: waelmmosa@yahoo.com.
authors.forename: Wael Mohamed Mohamed
authors.initials: WM
authors.lastname: Moussa
authors.affiliation: Department of Neurosurgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt.
authors.forename: Mohamed Abbas Aly
authors.initials: MA
authors.lastname: Mohamed
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006438:Hemodilution / Q000379:methods*; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D056990:Post-Exposure Prophylaxis / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control*; D012189:Retrospective Studies; D054556:Venous Thromboembolism / Q000175:diagnosis / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants
keywords: Deep venous thrombosis; Hemodilution; Low-molecular weight heparin (LMWH); Meningioma; Pulmonary embolism; Venous thromboembolism (VTE)