Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors

Kaisorn L. Chaichana, Courtney Pendleton, Christopher Jackson, Juan Carlos Martinez-Gutierrez, Andrea Diaz-Stransky, Javier Aguayo, Alessandro Olivi, Jon Weingart, Gary Gallia, Michael Lim, Henry Brem, Alfredo Quinones-Hinojosa

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. Methods: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. Results: Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.026-1.052; P<0.0001], high grade glioma (OR, 1.702; 95% CI, 1.176-2.465; P50.005), older age (OR, 1.033; 95% CI, 1.020- 1.046; P<0.0001), hypertension (OR, 1.785; 95% CI, 1.180-2.699; P50.006), and motor deficit (OR, 1.854; 95% CI, 1.244-2.763; P50.002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage. Discussion: The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.

Original languageEnglish (US)
Pages (from-to)206-211
Number of pages6
JournalNeurological Research
Volume35
Issue number2
DOIs
StatePublished - 2013
Externally publishedYes

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Craniotomy
Pulmonary Embolism
Brain Neoplasms
Venous Thrombosis
Odds Ratio
Confidence Intervals
Embolism
Glioma
Hypertension
Karnofsky Performance Status
Lung
Intracranial Hemorrhages
Low Molecular Weight Heparin
Tertiary Healthcare
Ambulatory Surgical Procedures
Neoplasms
Regression Analysis
Physicians

Keywords

  • Brain tumor
  • Deep vein thrombosis
  • Glioma
  • Heparin
  • Pulmonary embolism
  • Venothromboembolism

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology
  • Medicine(all)

Cite this

Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. / Chaichana, Kaisorn L.; Pendleton, Courtney; Jackson, Christopher; Martinez-Gutierrez, Juan Carlos; Diaz-Stransky, Andrea; Aguayo, Javier; Olivi, Alessandro; Weingart, Jon; Gallia, Gary; Lim, Michael; Brem, Henry; Quinones-Hinojosa, Alfredo.

In: Neurological Research, Vol. 35, No. 2, 2013, p. 206-211.

Research output: Contribution to journalArticle

Chaichana, KL, Pendleton, C, Jackson, C, Martinez-Gutierrez, JC, Diaz-Stransky, A, Aguayo, J, Olivi, A, Weingart, J, Gallia, G, Lim, M, Brem, H & Quinones-Hinojosa, A 2013, 'Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors', Neurological Research, vol. 35, no. 2, pp. 206-211. https://doi.org/10.1179/1743132812Y.0000000126
Chaichana KL, Pendleton C, Jackson C, Martinez-Gutierrez JC, Diaz-Stransky A, Aguayo J et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. Neurological Research. 2013;35(2):206-211. https://doi.org/10.1179/1743132812Y.0000000126
Chaichana, Kaisorn L. ; Pendleton, Courtney ; Jackson, Christopher ; Martinez-Gutierrez, Juan Carlos ; Diaz-Stransky, Andrea ; Aguayo, Javier ; Olivi, Alessandro ; Weingart, Jon ; Gallia, Gary ; Lim, Michael ; Brem, Henry ; Quinones-Hinojosa, Alfredo. / Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. In: Neurological Research. 2013 ; Vol. 35, No. 2. pp. 206-211.
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abstract = "Objective: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. Methods: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. Results: Of the 4293 patients in this study, 126 (3{\%}) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1.040; 95{\%} confidence interval (CI), 1.026-1.052; P<0.0001], high grade glioma (OR, 1.702; 95{\%} CI, 1.176-2.465; P50.005), older age (OR, 1.033; 95{\%} CI, 1.020- 1.046; P<0.0001), hypertension (OR, 1.785; 95{\%} CI, 1.180-2.699; P50.006), and motor deficit (OR, 1.854; 95{\%} CI, 1.244-2.763; P50.002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4{\%} of these patients developed intracranial hemorrhage. Discussion: The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.",
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AU - Chaichana, Kaisorn L.

AU - Pendleton, Courtney

AU - Jackson, Christopher

AU - Martinez-Gutierrez, Juan Carlos

AU - Diaz-Stransky, Andrea

AU - Aguayo, Javier

AU - Olivi, Alessandro

AU - Weingart, Jon

AU - Gallia, Gary

AU - Lim, Michael

AU - Brem, Henry

AU - Quinones-Hinojosa, Alfredo

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N2 - Objective: The development of venothromboembolisms (VTEs), including deep vein thrombosis (DVT) and pulmonary emboli (PE), is common in brain tumor patients. Their development can be catastrophic. Studies evaluating pre-operative clinical factors that predispose patients to the development of VTE are few and limited. An understanding may help risk stratify patients and guide subsequent therapy aimed at reducing the risk of DVTs/PEs. Methods: All adult patients who underwent surgery for an intracranial tumor at an academic tertiary care institution between 1998 and 2008 were retrospectively reviewed. Stepwise multivariate logistical regression analysis was used to identify pre-operative factors associated with the development of peri-operative (within 30 days of surgery) DVTs/PEs among patients who underwent surgery of their intracranial tumor. Results: Of the 4293 patients in this study, 126 (3%) patients developed DVT and/or PE in the peri-operative period. The pre-operative factors independently associated with the development of DVTs/PEs were: poorer Karnofsky performance scale (KPS) [odds ratio (OR), 1.040; 95% confidence interval (CI), 1.026-1.052; P<0.0001], high grade glioma (OR, 1.702; 95% CI, 1.176-2.465; P50.005), older age (OR, 1.033; 95% CI, 1.020- 1.046; P<0.0001), hypertension (OR, 1.785; 95% CI, 1.180-2.699; P50.006), and motor deficit (OR, 1.854; 95% CI, 1.244-2.763; P50.002). Eighty six per cent of the patients with DVTs/PEs were treated with either unfractionated or low molecular weight heparin, and 4% of these patients developed intracranial hemorrhage. Discussion: The present study found that poorer functional status, older age, pre-operative motor deficit, high grade glioma, and hypertension each independently increased the risk of developing peri-operative DVTs/PEs. These findings may provide patients and physicians with prognostic information that may guide therapies aimed at minimizing the development of peri-operative DVTs/PEs.

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KW - Glioma

KW - Heparin

KW - Pulmonary embolism

KW - Venothromboembolism

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