The Jefferson Manual for Neurocritical Care by Jallo Jack I.; Urtecho Jacqueline S.;

Author:Jallo, Jack I.; Urtecho, Jacqueline S.;
Language: eng
Format: epub
Publisher: Thieme Medical Publishers, Incorporated
Published: 2021-06-15T00:00:00+00:00

11.2.4 Venous Thromboembolism Prophylaxis

Venous thromboembolism (VTE) remains the most common adverse event affecting brain tumor patients in the postoperative setting, occurring in 3 to 26% of patients in the perioperative period.4,16 Unfortunately, there is a dearth of literature to provide meaningful guidance on balancing this risk with the risk of postoperative hemorrhage. The use of sequential compression devices (SCDs) in neurosurgical patients has been well described and is currently recommended for all postoperative patients.17 The optimal timing and dose of chemical thromboprophylaxis with either heparin or low-molecular-weight heparins (i.e., enoxaparin) remain unclear; however, most practitioners agree that starting low-dose prophylactic anticoagulation in the acute postoperative period is generally acceptable. Patients with significantly increased risk of thromboembolic complications, such as those with a mechanical heart valve, hypercoagulability, or history of deep vein thrombosis, initiation of mechanical and chemical thromboprophylaxis should be started as soon as possible.4,18 Patients with a paretic limb, patients on bevacizumab for recurrent GBM, and patients with malignant gliomas who are > 60 years old, are on active chemotherapy, and/or have a larger tumor burden, have also been showed to be at an increased risk for VTE.19,20 Ultimately, the timing for restarting thromboprophylactic medication must be based on the individual patient’s risk profile for both hemorrhage and thromboembolism.4,19,20

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