Naeem Komal, Bhargava Malika, Bohl Michael, Porter Randall W
Department of Neurosurgery, Barrow Neurological Institute, Phoenix, USA.
Cureus. 2021 Jun 2;13(6):e15404. doi: 10.7759/cureus.15404. eCollection 2021 Jun.
Introduction Venous thromboembolism (VTE) is the most common preventable cause of morbidity and mortality among neurosurgery patients. Several studies have concluded that the use of chemical prophylaxis among patients undergoing a craniotomy reduces the incidence of VTE, and it is presumed to be safe. However, these studies do not differentiate between a supratentorial and posterior fossa craniotomy. Furthermore, the prophylactic or therapeutic use of low-molecular-weight heparin (LMWH) has been reported to increase the risk of intracranial hemorrhage. In this study, we describe the clinical details and outcomes for all patients who underwent posterior fossa craniotomy and developed posterior fossa hemorrhage secondary to postoperative use of LMWH during the study period. We also propose recommendations pertaining to postoperative heparin use after posterior fossa surgeries. Methods Data were retrospectively collected for patients presenting with posterior fossa hemorrhage following anticoagulant use among those who previously underwent posterior fossa craniotomy by the senior author (R.W.P.) from January 1, 2011, through December 31, 2018. Results We identified five patients who experienced postoperative hemorrhage while receiving LMWH in the initial setting of posterior fossa craniotomy. After hemorrhaging, four patients had low Glasgow Outcome Scale (GOS) scores (≤3) and failed to return to their baseline neurological status. These four patients had a Glasgow Coma Scale (GCS) score of 15/15 in the immediate postoperative period and received heparin within 72 hours of surgery. Conclusions Based on our findings, there is a possible association between the increased risk of hemorrhage and the early postoperative use of LMWH. The debilitating outcomes among the majority of these patients warrant the cautious use and further investigation of postoperative LMWH to appropriately quantify the risk. Further comparative studies with a larger sample size are required to provide insight into the pathophysiology of our findings.
静脉血栓栓塞症（VTE）是神经外科患者中最常见的可预防的发病和死亡原因。多项研究得出结论，开颅手术患者使用化学预防措施可降低VTE的发生率，并且据推测是安全的。然而，这些研究并未区分幕上开颅手术和后颅窝开颅手术。此外，据报道，低分子量肝素（LMWH）的预防性或治疗性使用会增加颅内出血的风险。在本研究中，我们描述了在研究期间接受后颅窝开颅手术并因术后使用LMWH而发生后颅窝出血的所有患者的临床细节和结局。我们还提出了关于后颅窝手术后肝素使用的建议。方法：回顾性收集2011年1月1日至2018年12月31日期间由资深作者（R.W.P.）进行过先前的后颅窝开颅手术且在使用抗凝剂后出现后颅窝出血的患者的数据。结果：我们确定了5例在初次后颅窝开颅手术时接受LMWH治疗期间发生术后出血的患者。出血后，4例患者的格拉斯哥预后评分（GOS）较低（≤3），且未能恢复至基线神经状态。这4例患者在术后即刻格拉斯哥昏迷评分（GCS）为15/15，并在术后72小时内接受了肝素治疗。结论：基于我们的研究结果，出血风险增加与术后早期使用LMWH之间可能存在关联。这些患者中的大多数出现的致残性结局值得谨慎使用并进一步研究术后LMWH，以适当量化风险。需要进行更大样本量的进一步比较研究，以深入了解我们研究结果的病理生理学。
