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Thromb Haemost 2020; 120(03): 525-530
DOI: 10.1055/s-0039-3402732
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Nadroparin Plus Compression Stockings versus Nadroparin Alone for Prevention of Venous Thromboembolism in Cerebellopontine Angle Tumour Excisions: A Cohort Study

Raoul J. Koopmans 
1   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
,
Suzanne C. Cannegieter
2   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
3   Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Radboud W. Koot
1   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
,
Carmen L. A. Vleggeert-Lankamp
1   Department of Neurosurgery, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

12 September 2019

04 December 2019

Publication Date:
06 February 2020 (online)

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Abstract

Background Both compression stockings and low molecular weight heparin (LMWH) are used for the prevention of post-operative venous thromboembolism (VTE) in cerebellopontine angle (CPA) tumour excisions.

Objective In an attempt to optimise the prophylactic treatment in these patients, we compared LMWH (nadroparin) plus compression stockings to nadroparin as single therapy.

Methods Patients undergoing CPA tumour excision in the period between January 2014 and November 2015 received nadroparin as a single therapy. Patients treated since November 2015 received, in addition to this therapy, peri-operative compression stockings as VTE prophylaxis due to a change in protocol. VTE was defined as symptomatic deep vein thrombosis or pulmonary embolism and was confirmed via radiological imaging or autopsy.

Results A total of 146 consecutive patients were reviewed. Treatment groups were comparable with respect to demographics and risk factors. Six of the 60 patients (10.0%; 95% confidence interval [CI] 3.8–20.5) receiving nadroparin single therapy developed symptomatic VTE. One out of 86 patients (1.2%; 95% CI 0–6.3) treated with combination therapy developed VTE (p = 0.019) with a risk difference of 8.8% (95% CI 1.43–19.0). In comparison to combination therapy, nadroparin single therapy showed a relative risk of 8.6 (95% CI 1.1–69.6).

Conclusion Adding compression stockings to peri-operative nadroparin, as a prophylactic strategy for thromboembolic complications in patients undergoing surgical intervention for CPA tumours, was associated with a significant reduction in the occurrence of VTE.

Keywords

venous thromboembolism - cerebellopontine angle - low molecular weight heparin - nadroparin - compression stockings
 

  • References

  • 1 Gould MK, Garcia DA, Wren SM. , et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e227S-e277S
    CrossrefPubMedGoogle Scholar
  • 2 Mammen EF. Pathogenesis of venous thrombosis. Chest 1992; 102 (6, Suppl): 640S-644S
    CrossrefPubMedGoogle Scholar
  • 3 Lukassen J, Groen J, Jacobs W. , et al. Thromboembolic prophylaxis in neurosurgical practice: a review. J Spine 2015; 4 (199) 2
    PubMedGoogle Scholar
  • 4 Turpie AGG, Chin BSP, Lip GYH. Venous thromboembolism: pathophysiology, clinical features, and prevention. BMJ 2002; 325 (7369): 887-890
    CrossrefPubMedGoogle Scholar
  • 5 Bekelis K, Labropoulos N, Coy S. Risk of venous thromboembolism and operative duration in patients undergoing neurosurgical procedures. Neurosurgery 2017; 80 (05) 787-792
    CrossrefPubMedGoogle Scholar
  • 6 Khaldi A, Helo N, Schneck MJ, Origitano TC. Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg 2011; 114 (01) 40-46
    CrossrefPubMedGoogle Scholar
  • 7 Hamilton MG, Hull RD, Pineo GF. Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 1994; 34 (02) 280-296
    CrossrefPubMedGoogle Scholar
  • 8 Stecker M, Michel K, Antaky K, Cherian S, Koyfmann F. Risk factors for DVT/PE in patients with stroke and intracranial hemorrhage. Open Neurol J 2014; 8: 1-6
    PubMedGoogle Scholar
  • 9 Bonneville F, Sarrazin J-L, Marsot-Dupuch K. , et al. Unusual lesions of the cerebellopontine angle: a segmental approach. Radiographics 2001; 21 (02) 419-438
    CrossrefPubMedGoogle Scholar
  • 10 Fink JR. Imaging of cerebellopontine angle masses: self-assessment module. AJR Am J Roentgenol 2010; 195 (3, Suppl): S15-S21
    CrossrefPubMedGoogle Scholar
  • 11 Shupak A, Holdstein Y, Kaminer M, Braverman I. Primary solitary intralabyrinthine schwannoma: a report of 7 cases and a review of the literature. Ear Nose Throat J 2016; 95 (12) 481-491
    CrossrefPubMedGoogle Scholar
  • 12 Matthies C, Samii M. Management of 1000 vestibular schwannomas (acoustic neuromas): clinical presentation. Neurosurgery 1997; 40 (01) 1-9
    PubMedGoogle Scholar
  • 13 Barker II FG, Carter BS, Ojemann RG, Jyung RW, Poe DS, McKenna MJ. Surgical excision of acoustic neuroma: patient outcome and provider caseload. Laryngoscope 2003; 113 (08) 1332-1343
    CrossrefPubMedGoogle Scholar
  • 14 Sughrue ME, Kaur R, Rutkowski MJ. , et al. Extent of resection and the long-term durability of vestibular schwannoma surgery. J Neurosurg 2011; 114 (05) 1218-1223
    CrossrefPubMedGoogle Scholar
  • 15 Dickinson LD, Miller LD, Patel CP, Gupta SK. Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 1998; 43 (05) 1074-1081
    CrossrefPubMedGoogle Scholar
  • 16 Wang X, Zhou YC, Zhu WD. , et al. The risk of postoperative hemorrhage and efficacy of heparin for preventing deep vein thrombosis and pulmonary embolism in adult patients undergoing neurosurgery: a systematic review and meta-analysis. J Investig Med 2017; 65 (08) 1136-1146
    CrossrefPubMedGoogle Scholar
  • 17 Giordano NJ, Jansson PS, Young MN, Hagan KA, Kabrhel C. Epidemiology, pathophysiology, stratification, and natural history of pulmonary embolism. Tech Vasc Interv Radiol 2017; 20 (03) 135-140
    CrossrefPubMedGoogle Scholar
  • 18 Ribic C, Crowther M. Thrombosis and anticoagulation in the setting of renal or liver disease. Hematology (Am Soc Hematol Educ Program) 2016; 2016 (01) 188-195
    CrossrefPubMedGoogle Scholar
  • 19 Rosendaal FR. Causes of venous thrombosis. Thromb J 2016; 14 (Suppl. 01) 24
    CrossrefPubMedGoogle Scholar
  • 20 Ocak G, Vossen CY, Verduijn M. , et al. Risk of venous thrombosis in patients with major illnesses: results from the MEGA study. J Thromb Haemost 2013; 11 (01) 116-123
    CrossrefPubMedGoogle Scholar
  • 21 Turpie AG, Hirsh J, Gent M, Julian D, Johnson J. Prevention of deep vein thrombosis in potential neurosurgical patients. A randomized trial comparing graduated compression stockings alone or graduated compression stockings plus intermittent pneumatic compression with control. Arch Intern Med 1989; 149 (03) 679-681
    CrossrefPubMedGoogle Scholar
  • 22 Khan NR, Patel PG, Sharpe JP, Lee SL, Sorenson J. Chemical venous thromboembolism prophylaxis in neurosurgical patients: an updated systematic review and meta-analysis. J Neurosurg 2018; 129 (04) 906-915
    CrossrefPubMedGoogle Scholar
  • 23 Agnelli G, Piovella F, Buoncristiani P. , et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998; 339 (02) 80-85
    CrossrefPubMedGoogle Scholar