TABLE 6.
Summary of previous literature investigating the incidence of VTEs in adult patients undergoing elective craniotomy
| Authors & Year |
Study Design |
Population | Sample Size |
VTE (%) | DVT Screening |
PA (%) | Regimen | Day of PA Initiation |
Efficacy of PA* |
Hemorrhage (%) | VTE Risk Factors† |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Present study | Retro | Brain tumor | 1622 | 3.0 | No | 11.8 | Heparin 5000 U BID or TID, LMWH 30–40 mg QD, or oral AC | POD 4‡ | NA | 1.9 | ICH, motor deficit, older age, prior VTE, prolonged intubation |
| Joffe, 1975 | Retro | Craniotomy | 13 | 30.8 | Yes | 0.0 | — | — | — | NA | NA |
| Cerratoetal., 1978 | RCT | Craniotomy | 100 | 20.0 | Yes | 50.0 | Heparin 5000 U BID | PODO | Yes | 3.0 | NA |
| Ruff & Posner, 1983 | Retro | Glioma | 381 | 18.4 | No | 0.0 | — | — | — | 2.1 | NA |
| Bucci etal., 1989 | RCT | Craniotomy | 70 | 2.9 | Yes | 0.0 | — | — | — | NA | NA |
| Melon etal., 1991 | RCT | Craniotomy | 130 | 19.8 | Yes | 51.5 | LMWH 20 mg QD | POD 1 | No | 0.0 | NA |
| Frim et al., 1992 | Retro | Brain tumor | 611 | 2.5 | No | 22.6 | Heparin 5000 U BID | POD 1 | Yes | 0.0 | NA |
| Nurmohamed etal., 1996 | RCT | Craniotomy§ | 485 | 16.1 | Yes | 49.7 | LMWH¶ | PODO | Yes | 1.6 | NA |
| Flinn etal., 1996 | Prospect | Craniotomy | 1439 | 7.7 | Yes | 0.0 | — | — | — | NA | NA |
| Agnelli et al., 1998 | RCT | Craniotomy** | 259 | 24.6 | Yes | 50.2 | LMWH 40 mg QD | POD 1 | Yes | 3.0 | NA |
| Dickinson etal., 1998 | RCT | Brain tumor | 68 | 11.8 | Yes | 67.6 | LMWH 30 mg BID | Preop | No | 7.4 | NA |
| Constantini etal., 2001 | RCT | Brain tumor | 103 | 3.9 | No | 53.4 | Heparin 5000 U BID | Preop | NA | 2.9 | NA |
| Raabe etal., 2001 | Retro | Brain tumor | 690 | 1.2 | No | 100.0 | Heparin 5000 U TID | PODO | — | 2.5 | NA |
| Goldhaber et al., 2002 | RCT | Brain tumor | 150 | 9.3 | Yes | 100.0 | LMWH 40 mg QD | POD 1 | — | 0.7 | NA |
| Kumar et al., 2002 | Prospect | Brain tumor | 54 | 3.7 | Yes | 0.0 | — | — | — | NA | NA |
| Ting etal., 2002 | Prospect | Brain tumor | 100 | 4.0 | Yes | 0.0 | — | — | — | 1.0 | NA |
| Auguste et al., 2003 | Retro | Glioma | 180 | 3.3§ | No | 0.0 | — | — | — | NA | NA |
| Gerlach et al., 2003 | Prospect | Craniotomy | 1319 | 0.5 | No†† | 100.0 | LMWH 2850 U QD | Preop | — | 3.2 | NA |
| Macdonald et al., 2003 | RCT | Craniotomy | 100 | 2.0 | Yes | 100.0 | LMWH 2500 U BID or heparin 5000 UBID | PODO | No | 3.0 | NA |
| Gerber et al., 2007 | Retro | Meningioma | 224 | 4.9 | No | 90.0 | Heparin 5000 U BID | POD 1 | NA | 2.7 | Male, nonambulatory, increasing age |
| Cage etal., 2009 | Retro | Meningioma | 86 | 3.5 | No | 27.9 | LMWH 30–40 mg QD | POD 1–2 | No | 12.8 | NA |
| Dermody et al., 2011 | Retro | Cranioto-my‡‡ | 123 | 12.2 | Yes | 83.3 | Heparin 5000 U BID/TID or LMWH 40 mg QD | NA | Yes | NA | NA |
| Chaichana et al., 2013 | Retro | Brain tumor | 4293 | 3.0 | No | 100.0 | Heparin 5000 U BID or TID | POD 1 | NA | HGG, HTN, motor deficit, increasing age, poor functional status | |
| Prell etal., 2013 | Prospect | Craniotomy | 101 | 42.6 | Yes | 100.0 | LMWH 3000 IU QD | POD 1 | — | 2.0 | NA |
| Hoefnagel etal., 2014 | Retro | Brain tumor | 581 | 7.2 | No | 100.0 | LMWH 2850 or 5700 IU QD | POD 1 | — | 2.9 | Increasing weight, nonambulatory |
| Smith etal., 2014 | Retro | HGG | 336 | 15.7 | No | 7.4 | Heparin or LMWH¶ | POD 3‡ | Yes | 1.3 | ICU LOS, prior VTE, seizure |
| Frisius etal., 2015 | Retro | Brain tumor | 200 | 7.0 | Yes | 100.0 | LMWH¶ | POD 1–2 | NA | NA | NA |
| Smith et al., 2015 | Retro | Brain tumor | 1148 | 17.1 | No | 10.5 | Heparin or LMWH¶ | POD 5‡ | NA | 2.2 | Female, ICU LOS, HGG, metastasis, non-Caucasian, prior VTE |
| Sjavik et al., 2016 | Retro | Meningioma | 979 | 3.6 | No | 65.0 | LMWH 40 mg/5000 IU QD | Preop | No | 8.1 | NA |
| Agarwal etal., 2018 | Retro | Brain tumor | 800 | 1.6 | No | 100.0 | Heparin 5000 U TID | POD 2 | — | NA | NA |
| Guo et al., 2018 | Prospect | Brain tumor | 133 | 10.5 | Yes | 0.0 | — | — | — | NA | NA |
| Nakano et al., 2018 | Retro | Brain tumor | 61 | 21.3 | Yes | 0.0 | — | — | — | NA | Postop infection |
| Natsumeda et al., 2018 | Prospect | Craniotomy | 82 | 17.1 | Yes | 0.0 | — | — | — | NA | NA |
| Prell etal., 2018 | RCT | Craniotomy | 94 | 18.1 | Yes | 100.0 | LMWH 3000 U QD | POD 1 | — | NA | NA |
| 1975–2018§§ | — | — | 13–4293 (469.5) | 0.5–42.6(11.1) | Yes: 19/33 (57.6%) | 0.0–100.0(49.4) | — | — | Yes: 6/11 (54.5%) | 0.0–12.8(3.1) | — |
AC = anticoagulation; BID = twice daily; HGG = high-grade glioma; HTN = hypertension; ICU = intensive care unit; NA = not available; PA = prophylactic anticoagulation; POD = postoperative day; prospect = prospective; QD = daily; retro = retrospective; TID = 3 times daily; — = variable was not applicable to the study in question (e.g., regimen of PA in study in which no PA was administered).
Based on the study authors’ interpretation of results.
Risk factors noted only if found to be independently associated with VTEs on multivariate analysis.
Represents the mean postoperative day of prophylactic anticoagulation.
1.4% of patients in this study underwent spinal surgery.
Information on dosage and frequency of administration was not available.
15.0% of patients in this study had spine surgery.
100 patients were randomly screened for VTE in this study.
Diagnosis of postoperative VTE was assessed in first 6 weeks after surgery, as opposed to 30 days.
Summary of data for all studies.