Safaee Michael, Sun Matthew Z, Oh Taemin, Aghi Manish K, Berger Mitchel S, McDermott Michael W, Parsa Andrew T, Bloch Orin
Department of Neurological Surgery, University of California, San Francisco, USA.
Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, USA.
Clin Neurol Neurosurg. 2014 Apr;119:116-20. doi: 10.1016/j.clineuro.2014.01.021. Epub 2014 Jan 27.
Hemostatic agents are widely used in patients undergoing intracranial tumor resection to facilitate local hemostasis. We hypothesized that systemic activation of the clotting cascade after local application of hemostatic agents may result in unintended thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism (PE). We performed a retrospective analysis to identify potential associations between hemostatic agent use and DVT/PE.
A single-institution review of patients undergoing surgical resection of cranial meningiomas was performed. Patient demographics including gender and BMI, procedure duration, estimated blood loss (EBL), tumor pathology, use of hemostatic matrix, and the presence of DVT/PE within 14 days of surgery were collected from the medical record.
A total of 467 patients underwent a craniotomy for meningioma from 2009 to 2012. There were 331 women and 136 men with a mean age of 58 ± 14 years (range 18-92) and mean BMI of 28 ± 6. Tumor pathology included 359 grade I, 77 grade II, and 31 grade III tumors. There were 12 patients (2.6%) with thromboembolic events. Age (p=0.66), gender (p=0.33), EBL (p=0.99), and procedure duration (p=0.17) were not associated with an increased incidence of DVT/PE. Use of DVT prophylaxis initiated 72 h after surgery did not significantly alter the incidence of DVT/PE (p=0.20). Body mass index (p=0.04) and tumor grade (p=0.05) were associated with increased incidence of DVT/PE. Patients receiving greater than 10 ml of a hemostatic agent intraoperatively had an increased incidence of DVT/PE (p=0.02). In a multivariate model, both BMI (OR=1.07, 95% CI: 1.00-1.15, p=0.048) and use of more than 10 ml of hemostatic agent (OR=8.03, CI: 1.02-63.40, p=0.048) were found to be significantly associated with the risk of DVT/PE.
Hemostatic agents are valuable tools in modern neurosurgery, however their use may be associated with an increased risk of DVT/PE in patients undergoing meningioma resection. This finding provides the impetus for more definitive clinical and laboratory studies to characterize the biology of this association and helps identify patients at increased risk for thromboembolism. This study also affirms the association between high BMI and the risk of thromboembolism. Interestingly the use of prophylactic anticoagulation after surgery did not decrease the incidence of DVT/PE.
止血剂广泛应用于接受颅内肿瘤切除术的患者，以促进局部止血。我们推测，局部应用止血剂后凝血级联反应的全身激活可能导致意外的血栓栓塞事件，包括深静脉血栓形成（DVT）和肺栓塞（PE）。我们进行了一项回顾性分析，以确定止血剂使用与DVT/PE之间的潜在关联。
对接受颅底脑膜瘤手术切除的患者进行单机构回顾性研究。从病历中收集患者的人口统计学资料，包括性别和体重指数（BMI）、手术时间、估计失血量（EBL）、肿瘤病理学、止血基质的使用情况以及术后14天内DVT/PE的发生情况。
2009年至2012年共有467例患者接受了脑膜瘤开颅手术。其中女性331例，男性136例，平均年龄58±14岁（范围18 - 92岁），平均BMI为28±6。肿瘤病理学包括359例I级、77例II级和31例III级肿瘤。有12例患者（2.6%）发生血栓栓塞事件。年龄（p = 0.66）、性别（p = 0.33）、EBL（p = 0.99）和手术时间（p = 0.17）与DVT/PE发生率增加无关。术后72小时开始使用DVT预防措施并未显著改变DVT/PE的发生率（p = 0.20）。体重指数（p = 0.04）和肿瘤分级（p = 0.05）与DVT/PE发生率增加有关。术中接受超过10 ml止血剂的患者DVT/PE发生率增加（p = 0.02）。在多变量模型中，BMI（OR = 1.07，95%CI：1.00 - 1.15，p = 0.048）和使用超过10 ml止血剂（OR = 8.03，CI：1.02 - 63.40，p = 0.048）均与DVT/PE风险显著相关。
止血剂是现代神经外科手术中的重要工具，然而，在接受脑膜瘤切除术的患者中，其使用可能与DVT/PE风险增加有关。这一发现为更明确的临床和实验室研究提供了动力，以阐明这种关联的生物学机制，并有助于识别血栓栓塞风险增加的患者。本研究还证实了高BMI与血栓栓塞风险之间的关联。有趣的是，术后使用预防性抗凝并未降低DVT/PE的发生率。
