OBJECT: Thromboembolic phenomena (TEPs) continue to be a significant source of morbidity and mortality in patients undergoing neurosurgery. Although the efficacy of low-dose heparin in preventing TEPs in neurosurgical patients is well established, neurosurgeons are reluctant to use it perioperatively because of concern for increased bleeding complications. To clarify this issue, the authors used a prospective, randomized, double-blind design to evaluate the safety of minidose heparin treatment in patients undergoing surgery for supratentorial brain tumors. METHODS:One hundred three patients, all 40 years of age or older, were treated with either 5000 U of heparin (55 patients) orplacebo (48 patients) starting 2 hours before surgery and continuing until full mobilization or for 7 days. Both groups were well matched for sex, weight, duration of surgery, and tumor diagnosis. Subjective and objective parameters were used to estimate and calculate the perioperative bleeding tendency in all patients. Red blood cell mass loss was calculated by assessing the preoperative and postoperative hematocrit and the patient's weight. Intraoperative blood loss was determined by measuring the quantity of blood in the suction containers and subtracting the amount of irrigation fluids. Postoperative bleeding was measured by determining the amount of fluid in the subgaleal drain, and blood cell replacement was monitored during and after the procedure. Intracranial bleeding was graded according to findings on the postoperative computerized tomography scan obtained 48 to 72 hours after surgery. In addition, the senior surgeon in each case was asked to assess each patient's bleeding tendency during the operation. The results showed that perioperative administration of heparin did not significantly alter bleeding tendency by any measured parameter. The surgeon was blinded to which group individual patients had been allocated. CONCLUSIONS:Perioperative minidose heparin is safe for use in patients undergoing craniotomy for supratentorial tumors. This relatively simple and inexpensive measure is recommended as a routine regimen for the prevention of TEPs in patients undergoing neurosurgery.
RCT Entities:
OBJECT: Thromboembolic phenomena (TEPs) continue to be a significant source of morbidity and mortality in patients undergoing neurosurgery. Although the efficacy of low-dose heparin in preventing TEPs in neurosurgical patients is well established, neurosurgeons are reluctant to use it perioperatively because of concern for increased bleeding complications. To clarify this issue, the authors used a prospective, randomized, double-blind design to evaluate the safety of minidose heparin treatment in patients undergoing surgery for supratentorial brain tumors. METHODS: One hundred three patients, all 40 years of age or older, were treated with either 5000 U of heparin (55 patients) or placebo (48 patients) starting 2 hours before surgery and continuing until full mobilization or for 7 days. Both groups were well matched for sex, weight, duration of surgery, and tumor diagnosis. Subjective and objective parameters were used to estimate and calculate the perioperative bleeding tendency in all patients. Red blood cell mass loss was calculated by assessing the preoperative and postoperative hematocrit and the patient's weight. Intraoperative blood loss was determined by measuring the quantity of blood in the suction containers and subtracting the amount of irrigation fluids. Postoperative bleeding was measured by determining the amount of fluid in the subgaleal drain, and blood cell replacement was monitored during and after the procedure. Intracranial bleeding was graded according to findings on the postoperative computerized tomography scan obtained 48 to 72 hours after surgery. In addition, the senior surgeon in each case was asked to assess each patient's bleeding tendency during the operation. The results showed that perioperative administration of heparin did not significantly alter bleeding tendency by any measured parameter. The surgeon was blinded to which group individual patients had been allocated. CONCLUSIONS: Perioperative minidose heparin is safe for use in patients undergoing craniotomy for supratentorial tumors. This relatively simple and inexpensive measure is recommended as a routine regimen for the prevention of TEPs in patients undergoing neurosurgery.
Authors: Timothy R Smith; Rishi R Lall; Randall B Graham; Jamal Mcclendon; Rohan R Lall; Allan D Nanney; Joseph G Adel; Anaadriana Zakarija; James P Chandler Journal: J Neurooncol Date: 2014-07-26 Impact factor: 4.130
Authors: Juan José Yepes-Nuñez; Anita Rajasekhar; Maryam Rahman; Philipp Dahm; David R Anderson; Luis Enrique Colunga-Lozano; Stephanie Ross; Meha Bhatt; Kelly Estrada Orozco; Federico Popoff; Matthew Ventresca; Angela M Barbara; Sara Balduzzi; Housne Begum; Arnav Agarwal; Wojtek Wiercioch; Robby Nieuwlaat; Gian Paolo Morgano; Holger J Schünemann Journal: Blood Adv Date: 2020-06-23
Authors: Nasser Alshehri; David J Cote; M Maher Hulou; Ahmad Alghamdi; Ali Alshahrani; Rania A Mekary; Timothy R Smith Journal: J Neurooncol Date: 2016-09-03 Impact factor: 4.130
Authors: Lorenzo Rinaldo; Desmond A Brown; Adip G Bhargav; Aaron E Rusheen; Ryan M Naylor; Hannah E Gilder; Dileep D Monie; Stephanie J Youssef; Ian F Parney Journal: J Neurosurg Date: 2019-01-04 Impact factor: 5.115
Authors: Tene A Cage; Kathleen R Lamborn; Marcus L Ware; Anna Frankfurt; Lenna Chakalian; Mitchell S Berger; Michael W McDermott Journal: J Neurooncol Date: 2009-05-09 Impact factor: 4.130
Authors: Paul Nyquist; Cynthia Bautista; Draga Jichici; Joseph Burns; Sanjeev Chhangani; Michele DeFilippis; Fernando D Goldenberg; Keri Kim; Xi Liu-DeRyke; William Mack; Kim Meyer Journal: Neurocrit Care Date: 2016-02 Impact factor: 3.210