Goldhaber Samuel Z, Dunn Kelly, Gerhard-Herman Marie, Park John K, Black Peter McL
Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Chest. 2002 Dec;122(6):1933-7. doi: 10.1378/chest.122.6.1933.
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.
To minimize VTE among patients undergoing craniotomy for brain tumor.
Randomized, prospective, double-blind clinical trial.
Brigham and Women's Hospital.
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.
The rate of DVT detected by venous ultrasonography prior to hospital discharge.
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.
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.
静脉血栓栓塞症（VTE）是脑肿瘤开颅术后最常见的并发症。在布莱根妇女医院，脑肿瘤开颅术后的VTE是因非VTE相关疾病住院患者发生深静脉血栓形成（DVT）和肺栓塞（PE）的主要原因。
将脑肿瘤开颅手术患者的VTE风险降至最低。
随机、前瞻性、双盲临床试验。
布莱根妇女医院。
150例接受脑肿瘤开颅手术的患者被随机分为两组，一组接受依诺肝素，每日40毫克，另一组接受肝素，每日两次，每次5000单位，所有患者均使用分级压力袜和间歇性气动压迫装置。
出院前通过静脉超声检测DVT的发生率。
所有患者均未发生有症状的DVT或PE。无症状VTE的总体发生率为9.3%，两组预防措施组之间的发生率无显著差异。14例确诊为VTE的患者中有10例血栓仅限于小腿深静脉。
依诺肝素每日40毫克或普通肝素每日两次，每次5000单位，联合分级压力袜、间歇性气动压迫装置以及出院前对腿部进行静脉超声监测，使得连续150例患者未发生有症状的VTE。无症状VTE的低发生率9.3%主要为孤立的小腿DVT。因此，这种综合的多模式VTE预防方法取得了极佳的疗效和安全性。
