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Briggs RG, Lin YH, Dadario NB, et al. Optimal timing of post-operative enoxaparin after neurosurgery: A single institution experience. Clin Neurol Neurosurg. 2021;207:106792doi: 10.1016/j.clineuro.2021.106792.
Briggs, R. G., Lin, Y. H., Dadario, N. B., Young, I. M., Conner, A. K., Xu, W., Tanglay, O., Kim, S. J., Fonseka, R. D., Bonney, P. A., Chakraborty, A. R., Nix, C. E., Flecher, L. R., Yeung, J. T., Teo, C., & Sughrue, M. E. (2021). Optimal timing of post-operative enoxaparin after neurosurgery: A single institution experience. Clinical neurology and neurosurgery, 207106792. https://doi.org/10.1016/j.clineuro.2021.106792
Briggs, Robert G, et al. "Optimal timing of post-operative enoxaparin after neurosurgery: A single institution experience." Clinical neurology and neurosurgery vol. 207 (2021): 106792. doi: https://doi.org/10.1016/j.clineuro.2021.106792
Briggs RG, Lin YH, Dadario NB, Young IM, Conner AK, Xu W, Tanglay O, Kim SJ, Fonseka RD, Bonney PA, Chakraborty AR, Nix CE, Flecher LR, Yeung JT, Teo C, Sughrue ME. Optimal timing of post-operative enoxaparin after neurosurgery: A single institution experience. Clin Neurol Neurosurg. 2021 Aug;207:106792. doi: 10.1016/j.clineuro.2021.106792. Epub 2021 Jun 30. PMID: 34233235.
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Clin Neurol Neurosurg. 2021 Aug;207:106792. doi: 10.1016/j.clineuro.2021.106792. Epub 2021 Jun 30.

Optimal timing of post-operative enoxaparin after neurosurgery: A single institution experience.

Clinical neurology and neurosurgery

Robert G Briggs, Yueh-Hsin Lin, Nicholas B Dadario, Isabella M Young, Andrew K Conner, Wenjai Xu, Onur Tanglay, Sihyong J Kim, R Dineth Fonseka, Phillip A Bonney, Arpan R Chakraborty, Cameron E Nix, Lyke R Flecher, Jacky T Yeung, Charles Teo, Michael E Sughrue

Affiliations

  1. Department of Neurosurgery, University of Southern California, Los Angeles, California.
  2. Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
  3. Rutgers Robert Wood Johnson School of Medicine, New Brunswick, New Jersey.
  4. Cingulum Health, Sydney, Australia.
  5. Department of Neurosurgery, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma.
  6. Centre for Minimally Invasive Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia. Electronic address: [email protected].

PMID: 34233235 DOI: 10.1016/j.clineuro.2021.106792

Abstract

PURPOSE: Venous thromboembolism (VTE) is a well-known problem in patients with intracranial tumors, especially high-grade gliomas. Optimal management of VTE complications is critical given that the development of deep vein thrombosis (DVT) and/or pulmonary embolism can exacerbate medical comorbidities and increase mortality. However, little is known about the optimum time to initiate post-operative anticoagulant prophylaxis. Therefore, there is a keen interest amongst neurosurgeons to develop evidence-based protocols to prevent VTE in post-operative brain tumor patients.

METHODS: We retrospectively identified adult patients who underwent elective craniotomy for intracranial tumor resection between 2012 and 2017. Patients were categorized according to the time at which they began receiving prophylactic enoxaparin in the immediate post-operative period, within one day (POD 1), two days (POD 2), three days (POD 3), five days (POD 5), or seven days (POD 7).

RESULTS: A total of 1087 patients had a craniotomy for intracranial tumor resection between 2012 and 2017. Multivariate binomial logistic regression analysis demonstrated that initiation of prophylactic enoxaparin within 72 h of surgery was protective against the likelihood of developing a lower extremity DVT (OR: 0.32; CI: 0.10-0.95; p = 0.049) while controlling for possible risk factors for DVTs identified on univariate analysis. Furthermore, complication rates between the anticoagulation and non-anticoagulation groups were not statistically significant.

CONCLUSION: Initiating anticoagulant prophylaxis with subcutaneous enoxaparin sodium 40 mg once per day within 72 h of surgery can be done safely while reducing the risk of developing lower extremity DVT.

Copyright © 2021. Published by Elsevier B.V.

Keywords: Anticoagulation; DVT; Deep vein thrombosis; Intracranial lesion; Intracranial tumor

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