Smith Timothy R, Nanney Allan D, Lall Rishi R, Graham Randall B, McClendon Jamal, Lall Rohan R, Adel Joseph G, Zakarija Anaadriana, Cote David J, Chandler James P
Department of Neurosurgery, Brigham and Women's Hospital, 15 Francis Street-PBB3, Boston, MA 02115, USA.
Department of Neurosurgery, Northwestern University, Chicago, IL, USA.
J Clin Neurosci. 2015 Mar;22(3):519-25. doi: 10.1016/j.jocn.2014.10.003. Epub 2014 Dec 18.
Patients who undergo craniotomy for brain neoplasms have a high risk of developing venous thromboembolism (VTE), including deep vein thromboses (DVT) and pulmonary emboli (PE). The reasons for this correlation are not fully understood. This retrospective, single-center review aimed to determine the risk factors for VTE in patients who underwent neurosurgical resection of brain tumors at Northwestern University from 1999 to 2010. Our cohort included 1148 patients, 158 (13.7%) of whom were diagnosed with DVT and 38 (3.3%) of whom were diagnosed with PE. A variety of clinical factors were studied to determine predictors of VTE, including sex, ethnicity, medical co-morbidities, surgical positioning, length of hospital stay, tumor location, and tumor histology. Use of post-operative anticoagulants and hemorrhagic complications were also investigated. A prior history of VTE was found to be highly predictive of post-operative DVT (odds ratio [OR]=7.6, p=0.01), as was the patient's sex (OR=14.2, p<0.001), ethnicity (OR=0.5, p=0.04), post-operative intensive care unit days (OR=0.2, p=0.003), and tumor histology (OR=-0.16, p=0.01). Contrary to reports in the literature, the data collected did not indicate that the administration of post-operative medical prophylaxis for VTE was significant in preventing their formation (OR=-0.14, p=0.76). Hemorrhagic complications were low (2.2%) and resultant neurologic deficit was lower still (0.7%). The study indicates that patients with high-grade primary brain tumors and metastatic lesions should receive aggressive preventative measures in the post-operative period.
接受脑肿瘤开颅手术的患者发生静脉血栓栓塞（VTE）的风险很高，包括深静脉血栓形成（DVT）和肺栓塞（PE）。这种关联的原因尚未完全明确。这项回顾性单中心研究旨在确定1999年至2010年在西北大学接受脑肿瘤神经外科切除术的患者发生VTE的风险因素。我们的队列包括1148例患者，其中158例（13.7%）被诊断为DVT，38例（3.3%）被诊断为PE。研究了多种临床因素以确定VTE的预测因素，包括性别、种族、合并疾病、手术体位、住院时间、肿瘤位置和肿瘤组织学。还调查了术后抗凝剂的使用和出血并发症。发现VTE既往史对术后DVT具有高度预测性（比值比[OR]=7.6，p=0.01），患者的性别（OR=14.2，p<0.001）、种族（OR=0.5，p=0.04）、术后重症监护病房天数（OR=0.2，p=0.003）和肿瘤组织学（OR=-0.16，p=0.01）也是如此。与文献报道相反，收集的数据并未表明术后预防性使用VTE药物对预防其形成具有显著意义（OR=-0.14，p=0.76）。出血并发症发生率较低（2.2%），由此导致的神经功能缺损更低（0.7%）。该研究表明，患有高级别原发性脑肿瘤和转移性病变的患者在术后应采取积极的预防措施。
