Reduced risk of venous thromboembolism with the use of intermittent pneumatic compression after craniotomy: a randomized controlled prospective study

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OBJECTIVE

The term “venous thromboembolism” (VTE) subsumes deep venous thrombosis (DVT) and pulmonary embolism. The incidence of DVT after craniotomy was reported to be as high as 50%. Even clinically silent DVT may lead to potentially fatal pulmonary embolism. The risk of VTE is correlated with duration of surgery, and it appears likely that it develops during surgery. The present study aimed to evaluate intraoperative use of intermittent pneumatic compression (IPC) of the lower extremity for prevention of VTE in patients undergoing craniotomy.

METHODS

A total of 108 patients undergoing elective craniotomy for intracranial pathology were included in a single-center controlled randomized prospective study. In the control group, conventional compression stockings were worn during surgery. In the treatment group, IPC of the calves was used in addition. The presence of DVT was evaluated by Doppler sonography pre- and postoperatively.

RESULTS

Intraoperative use of IPC led to a significant reduction of VTE (p = 0.029). In logistic regression analysis, the risk of VTE was approximately quartered by the use of IPC. Duration of surgery was confirmed to be correlated with VTE incidence (p < 0.01); every hour of surgery increased the risk by a factor of 1.56.

CONCLUSIONS

Intraoperative use of IPC significantly lowers the incidence of potentially fatal VTE in patients undergoing craniotomy. The method is easy to use and carries no additional risks.

■ CLASSIFICATION OF EVIDENCE Type of question: therapeutic; study design: randomized controlled trial; evidence: class I.

Clinical trial registration no.: DRKS00011783 (https://www.drks.de)

ABBREVIATIONS DVT = deep venous thrombosis; IPC = intermittent pneumatic compression; LMWH = low-molecular-weight heparin; PE = pulmonary embolism; VTE = venous thromboembolism

Article Information

Correspondence Julian Prell: University of Halle, Germany. julian.prell@medizin.uni-halle.de.

INCLUDE WHEN CITING Published online March 30, 2018; DOI: 10.3171/2017.9.JNS17533.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

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Figures

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    Administration of IPC sleeves. Calf-length sleeves were used in all patients. The picture shows the operative setup and the air pulse generator. Figure is available in color online only.

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    Bar graph showing incidence of proximal and distal DVT. The figure shows the difference between the IPC and control groups; the incidence of DVT was significantly higher in the control group. No proximal DVT was observed in the IPC group. Values on the y-axis denote percentages. Figure is available in color online only.

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    Bar graph showing VTE incidence. This figure shows the incidence of VTE for the IPC and control groups in general (the 2 left-hand bars) and with each leg taken into account separately (the 2 right-hand bars). According to the latter calculation, the difference between both groups reached high significance (p < 0.001). Figure is available in color online only.

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