Hallan David R, Sciscent Bao, Rizk Elias
Neurosurgery, Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Cureus. 2022 Apr 6;14(4):e23867. doi: 10.7759/cureus.23867. eCollection 2022 Apr.
Post-operative venous thromboembolism (VTE) prophylaxis is the standard of care after craniotomy, but there is debate over when to initiate VTE prophylaxis to decrease the morbidity and mortality experienced by these patients. This study aims to determine the effects of starting enoxaparin on day one vs. day three after craniotomy.
We used a multi-institutional health research network (TriNetX) to gather data from the electronic medical records of patients who started enoxaparin one day after craniotomy (cohort 1) and patients who started it three days later (cohort 2). Our primary endpoint was mortality, with the secondary endpoints of deep venous thrombosis (DVT), additional craniotomy, pulmonary embolism (PE), myocardial infarction (MI), ischemic stroke (IS), intracerebral hemorrhage (ICH), ventilator and tracheostomy dependence, or percutaneous endoscopic gastrostomy (PEG) tube dependence. Patients were propensity score-matched for demographics, common comorbidities, and anticoagulant and antiplatelet use.
After propensity score matching, 1,554 patients were identified in each cohort. In cohort 1, 21.171% of patients were deceased after five years vs. 26.126% in cohort 2 (p= 0.0012; OR 0.759, 95% CI (0.643,0.897)). The 30-day survival was 94.521% vs. 93.049%, the 90-day survival was 90.200% vs. 87.335%, and the 365-day survival was 80.619 vs. 76.817%. Deep venous thrombosis occurred in 5.277% of cohort 1 and 7.851% of cohort 2 (p=0.0038, OR 0.654, 95% CI [0.49,0.873]). There was no increase in intracerebral hemorrhage in cohort 1. There were no statistically significant differences in subsequent craniotomy rates, PE, MI, IS, ventilator/tracheostomy, or PEG tube dependence.
Starting enoxaparin on day one after craniotomy was associated with decreased mortality and DVTs, with no difference in rates of PE, MI, IS, tracheostomy/PEG dependence, or further craniotomy.
术后静脉血栓栓塞症（VTE）预防是开颅术后的标准治疗措施，但对于何时开始进行VTE预防以降低这些患者的发病率和死亡率存在争议。本研究旨在确定开颅术后第一天与第三天开始使用依诺肝素的效果。
我们使用了一个多机构健康研究网络（TriNetX），从开颅术后一天开始使用依诺肝素的患者（队列1）和三天后开始使用依诺肝素的患者（队列2）的电子病历中收集数据。我们的主要终点是死亡率，次要终点包括深静脉血栓形成（DVT）、再次开颅、肺栓塞（PE）、心肌梗死（MI）、缺血性卒中（IS）、脑出血（ICH）、呼吸机和气管造口依赖或经皮内镜下胃造口术（PEG）管依赖。对患者的人口统计学、常见合并症以及抗凝和抗血小板药物的使用进行倾向评分匹配。
经过倾向评分匹配后，每个队列中确定了1554例患者。在队列1中，五年后21.171%的患者死亡，而队列2中为26.126%（p = 0.0012；OR 0.759，95% CI [0.643,0.897]）。30天生存率分别为94.521%和93.049%，90天生存率分别为90.200%和87.335%，365天生存率分别为80.619%和76.817%。队列1中5.277%的患者发生深静脉血栓形成，队列2中为7.851%（p = 0.0038，OR 0.654，95% CI [0.49,0.873]）。队列1中脑出血没有增加。在后续开颅率、肺栓塞、心肌梗死、缺血性卒中、呼吸机/气管造口或PEG管依赖方面没有统计学上的显著差异。
开颅术后第一天开始使用依诺肝素与死亡率降低和深静脉血栓形成减少相关，在肺栓塞、心肌梗死、缺血性卒中、气管造口/PEG依赖或再次开颅率方面没有差异。
