Fluss Rose, Kobets Andrew J, Inocencio Julio F, Hamad Mousa, Feigen Chaim, Altschul David J, Lasala Patrick
Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.
Leo M. Davidoff Department of Neurological Surgery, Montefiore Medical Center, Einstein College of Medicine, Bronx, NY, United States.
Clin Neurol Neurosurg. 2021 Feb;201:106460. doi: 10.1016/j.clineuro.2020.106460. Epub 2021 Jan 5.
Historically, the development of venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary thromboembolism (PE) was cited as a higher post-operative risk for patients harboring meningiomas. However, recent literature has suggested that there may be no elevated risk for VTE among these patients. The authors perform both a retrospective review of their own cases as well as a systematic review of the literature in order to determine the frequency of the VTE and rate of post-operative hemorrhage in this patient population.
Patients undergoing surgery for intracranial and spinal meningioma from 2012 to 2019 were retrospectively reviewed for patient demographics, clinical characteristics, and post-operative complications. Logistic regression was used to determine risk factors for the development of VTE. Additionally, a PubMed search was performed to identify patients addressing this topic.
Our retrospective review included 189 patients who underwent 197 operations. The rate of VTE for patients receiving LMWH was 3.55 % vs. 4.06 % for those not receiving LMWH. There were no observed hemorrhages after initiation of LMWH. Multivariate analysis found tumor volume, history of DVT, and length of hospital stay as independent risk factors for VTE. In the systematic review, 11 papers describing 28,954 patients were included. The risk of developing a VTE with or without LMWH was 2.71 % versus 4.07 %, respectively. The hemorrhage risk was 2.23 % on LMWH versus 4.20 % not on LMWH.
In several heterogeneous series of all types of neurosurgical procedures, the reported rate of VTE was 11.1 %. In our review of the literature, the VTE rate of 2.71 % was similar to our cohort's rate of 3.55 %, for patients administered LMWH postoperatively. Higher rates of VTE with meningiomas may not be the case as once thought. Regular use of LMWH appears to be a safe, but it also did not necessarily lower the rates of VTE in our cohort. The use of routine lower-extremity duplex ultrasound, mechanical prophylaxis, and early mobilization, may have contributed to these lower rates of VTEs in patients with meningiomas.
从历史上看，静脉血栓栓塞症（VTE）包括深静脉血栓形成（DVT）和肺血栓栓塞症（PE）的发生被认为是脑膜瘤患者术后更高的风险。然而，最近的文献表明，这些患者中VTE风险可能并未升高。作者对他们自己的病例进行了回顾性研究，并对文献进行了系统回顾，以确定该患者群体中VTE的发生率和术后出血率。
对2012年至2019年接受颅内和脊髓脑膜瘤手术的患者进行回顾性研究，分析患者的人口统计学、临床特征和术后并发症。采用逻辑回归分析确定VTE发生的危险因素。此外，通过PubMed搜索来确定涉及该主题的患者。
我们的回顾性研究纳入了189例患者，共进行了197次手术。接受低分子肝素（LMWH）治疗的患者VTE发生率为3.55%，未接受LMWH治疗的患者为4.06%。开始使用LMWH后未观察到出血情况。多因素分析发现肿瘤体积、DVT病史和住院时间是VTE的独立危险因素。在系统回顾中，纳入了11篇描述28954例患者的论文。使用或未使用LMWH发生VTE的风险分别为2.71%和4.07%。使用LMWH时出血风险为2.23%，未使用时为4.20%。
在各类神经外科手术的几个不同系列研究中，报道的VTE发生率为11.1%。在我们的文献回顾中，术后接受LMWH治疗的患者VTE发生率为2.71%，与我们队列中的3.55%相似。脑膜瘤患者VTE发生率可能并不像曾经认为的那样高。定期使用LMWH似乎是安全的，但在我们的队列中它也不一定能降低VTE发生率。常规使用下肢双功超声、机械预防措施和早期活动，可能是脑膜瘤患者VTE发生率较低的原因。
