Length of Thromboprophylaxis in Patients Operated on for a High-Grade Glioma: A Retrospective Study.

Adult; Aged; Anticoagulants/administration & dosage/adverse effects; Cerebral Hemorrhage/chemically induced/diagnosis; Cohort Studies; Craniotomy/adverse effects/trends; Female; Glioma/diagnosis/surgery; Heparin, Low-Molecular-Weight/administration & dosage/adverse effects; Humans; Male; Middle Aged; Patient Discharge/trends; Post-Exposure Prophylaxis/methods/trends; Retrospective Studies; Time Factors; Venous Thromboembolism/diagnosis/etiology/prevention & control; High-grade glioma; Intracranial hemorrhage; Low-molecular-weight heparin; Thromboprophylaxis; Venous thromboembolism

Abstract :

[en] OBJECTIVE: High-grade gliomas are associated with venous thromboembolism (VTE). This retrospective study with a parallel cohort design investigated influence of continuing prophylactic anticoagulation after discharge on rate of VTE and intracranial hemorrhage (ICH) in patients operated on for high-grade glioma. METHODS: Consecutive adult patients who underwent subtotal or gross total resection for high-grade glioma at a single institution were included. Multivariable logistic regression analysis was used to investigate the association between duration of thromboprophylaxis (dalteparin administered 21 days vs. 0-7 days) and occurrence of VTE and ICH within 21 or 90 days after surgery, corrected for known risk factors. RESULTS: Of 301 included patients, 166 received short-term thromboprophylaxis, and 135 received prolonged thromboprophylaxis. In multivariable analysis, prolonged thromboprophylaxis was not significantly associated with occurrence of VTE within 21 days (3.0% vs. 1.2%; P = 0.24) or 90 days (8.9% vs. 4.8%; P = 0.09) after surgery; however, prolonged prophylaxis was associated with occurrence of ICH (5.9% vs. 0.6%; P = 0.03). Additionally, immobility (P = 0.03) and high body mass index (P = 0.02) were associated with occurrence of VTE. CONCLUSIONS: Prophylactic anticoagulation for 21 days postoperatively was not associated with a decreased rate of VTE compared with thromboprophylaxis until discharge. ICH was more common with prolonged thromboprophylaxis. These results provide insufficient evidence to extend duration of prophylaxis beyond hospitalization. Large-scale randomized prospective studies are needed to clarify safety, efficacy, and optimal timing of postoperative thromboprophylaxis in patients with high-grade glioma.

Disciplines :

Genetics & genetic processes

Author, co-author :

Senders, Joeky T.

Snijders, Tom J.

van Essen, Max

van Bentum, Gaby M.

Seute, Tatjana

de Vos, Filip Y.

Smith, Timothy R.

Robe, Pierre ; Université de Liège - ULiège > Département des sciences biomédicales et précliniques > Département des sciences biomédicales et précliniques

Broekman, Marike L. D.

Language :

English

Title :

Length of Thromboprophylaxis in Patients Operated on for a High-Grade Glioma: A Retrospective Study.

Publication date :

2018

Journal title :

World Neurosurgery

ISSN :

1878-8750

eISSN :

1878-8769

Publisher :

Elsevier, Netherlands

Volume :

115

Pages :

e723-e730

Peer reviewed :

Peer Reviewed verified by ORBi

Commentary :

Available on ORBi :

since 07 January 2019

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Bibliography

Walker, A.J., Card, T.R., West, J., Crooks, C., Grainge, M.J., Incidence of venous thromboembolism in patients with cancer—a cohort study using linked United Kingdom databases. Eur J Cancer 49 (2013), 1404–1413.
Constantini, S., Kornowski, R., Pomeranz, S., Rappaport, Z.H., Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumors. Acta Neurochir 109 (1991), 93–97.
Chaichana, K.L., Pendleton, C., Jackson, C., Martinez-Gutierrez, J.C., Diaz-Stransky, A., Aguayo, J., et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. Neurol Res 35 (2013), 206–211.
Brandes, A.A., Scelzi, E., Salmistraro, G., Ermani, M., Carollo, C., Berti, F., et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer 33 (1997), 1592–1596.
Streiff, M.B., Segal, J., Grossman, S.A., Kickler, T.S., Weir, E.G., ABO blood group is a potent risk factor for venous thromboembolism in patients with malignant gliomas. Cancer 100 (2004), 1717–1723.
Smith, T.R., Lall, R.R., Graham, R.B., Mcclendon, J. Jr., Lall, R.R., Nanney, A.D., et al. Venous thromboembolism in high grade glioma among surgical patients: results from a single center over a 10 year period. J Neurooncol 120 (2014), 347–352.
Simanek, R., Vormittag, R., Hassler, M., Roessler, K., Schwarz, M., Zielinski, C., et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol 9 (2007), 89–95.
Semrad, T.J., O'Donnell, R., Wun, T., Chew, H., Harvey, D., Zhou, H., et al. Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 106 (2007), 601–608.
Robins, H.I., O'Neill, A., Gilbert, M., Olsen, M., Sapiente, R., Berkey, B., et al. Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial. Cancer Chemother Pharmacol 62 (2008), 227–233.
Perry, S.L., Bohlin, C., Reardon, D.A., Desjardins, A., Friedman, A.H., Friedman, H.S., et al. Tinzaparin prophylaxis against venous thromboembolic complications in brain tumor patients. J Neurooncol 95 (2009), 129–134.
Perry, J.R., Julian, J.A., Laperriere, N.J., Geerts, W., Agnelli, G., Rogers, L.R., et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost 8 (2010), 1959–1965.
Pan, E., Tsai, J.S., Mitchell, S.B., Retrospective study of venous thromboembolic and intracerebral hemorrhagic events in glioblastoma patients. Anticancer Res 29 (2009), 4309–4313.
Edwin, N.C., Khoury, M.N., Sohal, D., McCrae, K.R., Ahluwalia, M.S., Khorana, A.A., Recurrent venous thromboembolism in glioblastoma. Thromb Res 137 (2016), 184–188.
Cheruku, R., Tapazoglou, E., Ensley, J., Kish, J.A., Cummings, G.D., al-Sarraf, M., The incidence and significance of thromboembolic complications in patients with high-grade gliomas. Cancer 68 (1991), 2621–2624.
Yust-Katz, S., Mandel, J.J., Wu, J., Yuan, Y., Webre, C., Pawar, T.A., et al. Venous thromboembolism (VTE) and glioblastoma. J Neurooncol 124 (2015), 87–94.
Ruff, R.L., Posner, J.B., Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 13 (1983), 334–336.
Quevedo, J.F., Buckner, J.C., Schmidt, J.L., Dinapoli, R.P., O'Fallon, J.R., Thromboembolism in patients with high-grade glioma. Mayo Clin Proc 69 (1994), 329–332.
Dhami, M.S., Bona, R.D., Calogero, J.A., Hellman, R.M., Venous thromboembolism and high grade gliomas. Thromb Haemost 70 (1993), 393–396.
Streiff, M.B., Ye, X., Kickler, T.S., Desideri, S., Jani, J., Fisher, J., et al. A prospective multicenter study of venous thromboembolism in patients with newly-diagnosed high-grade glioma: hazard rate and risk factors. J Neurooncol 124 (2015), 299–305.
Dickinson, H., Carico, C., Nuño, M., Mukherjee, D., Ortega, A., Black, K.L., et al. Unplanned readmissions and survival following brain tumor surgery. J Neurosurg 122 (2015), 61–68.
Nabi, S., Kahlon, P., Bozorgnia, F., Arshad, A., Mikkelsen, T., Donthireddy, V., Predictors of venous thromboembolism in patients with glioblastoma. Pathol Oncol Res 22 (2016), 311–316.
Rodas, R.A., Fenstermaker, R.A., McKeever, P.E., Blaivas, M., Dickinson, L.D., Papadopoulos, S.M., et al. Correlation of intraluminal thrombosis in brain tumor vessels with postoperative thrombotic complications: a preliminary report. J Neurosurg 89 (1998), 200–205.
Misch, M., Czabanka, M., Dengler, J., Stoffels, M., Auf, G., Vajkoczy, P., et al. D-dimer elevation and paresis predict thromboembolic events during bevacizumab therapy for recurrent malignant glioma. Anticancer Res 33 (2013), 2093–2098.
Streiff, M.B., NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®). Cancer-Associated Venous Thromboembolic Disease. Version 1.2014. 2014, National Comprehensive Cancer Network, Fort Washington, PA.
Farge, D., Bounameaux, H., Brenner, B., Cajfinger, F., Debourdeau, P., Khorana, A.A., et al. International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 17 (2016), e452–e466.
Lyman, G.H., Bohlke, K., Khorana, A.A., American Society of Clinical Oncology. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update 2014. J Clin Oncol 33 (2015), 654–656.
Farge, D., Debourdeau, P., Beckers, M., Baglin, C., Bauersachs, R.M., Brenner, B., et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 11 (2013), 56–70.
Strangman, D., Clinical Practice Guidelines for the Management of Adult Gliomas: Astrocytomas and Oligodendrogliomas. 2009, Cancer Council Australia/Australian Cancer Network/Clinical Oncological Society of Australia, Sydney.
Guyatt, G.H., Akl, E.A., Crowther, M., Gutterman, D.D., Schuünemann, H.J., American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141:2 suppl (2012), 7S–47S.
Carman, T.L., Kanner, A.A., Barnett, G.H., Deitcher, S.R., Prevention of thromboembolism after neurosurgery for brain and spinal tumors. South Med J 96 (2003), 17–22.
Zwicker, J.I., Karp Leaf, R., Carrier, M., A meta-analysis of intracranial hemorrhage in patients with brain tumors receiving therapeutic anticoagulation. J Thromb Haemost 14 (2016), 1736–1740.
Senders, J.T., Goldhaber, N.H., Cote, D.J., Muskens, I.S., Dawood, H.Y., De Vos, F.Y.F.L., et al. Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis. J Neuro-oncol 136 (2018), 135–145.
Mantia, C., Uhlmann, E.J., Puligandla, M., Weber, G.M., Neuberg, D., Zwicker, J.I., Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood 129 (2017), 3379–3385.
Al Megren, M., De Wit, C., Al Qahtani, M., Le Gal, G., Carrier, M., Management of venous thromboembolism in patients with glioma. Thromb Res 156 (2017), 105–108.