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.

Headings

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.

  • View in gallery

    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.

  • View in gallery

    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.

References

1

Agnelli GPiovella FBuoncristiani PSeveri PPini MD’Angelo A: Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339:80851998

2

Algattas HDamania DDeAndrea-Lazarus IKimmell KTMarko NFWalter KA: Systematic review of safety and cost-effectiveness of venous thromboembolism prophylaxis strategies in patients undergoing craniotomy for brain tumor. Neurosurgery [epub ahead of print]2017

3

Auguste KIQuiñones-Hinojosa ABerger MS: Efficacy of mechanical prophylaxis for venous thromboembolism in patients with brain tumors. Neurosurg Focus 17(4):E32004

4

Bagot CNArya R: Virchow and his triad: a question of attribution. Br J Haematol 143:1801902008

5

Caggiati ABergan JJGloviczki PEklof BAllegra CPartsch H: Nomenclature of the veins of the lower limb: extensions, refinements, and clinical application. J Vasc Surg 41:7197242005

6

Calnan JSPflug JJMills CJ: Pneumatic intermittent-compression legging simulating calf-muscle pump. Lancet 2:5025031970

7

Chan ATAtiemo ADiran LKLicholai GPMcLaren Black PCreager MA: Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis. J Thromb Thrombolysis 8:1391421999

8

Comerota AJChouhan VHarada RNSun LHosking JVeermansunemi R: The fibrinolytic effects of intermittent pneumatic compression: mechanism of enhanced fibrinolysis. Ann Surg 226:3063141997

9

Comerota AJKatz MLWhite JV: Why does prophylaxis with external pneumatic compression for deep vein thrombosis fail? Am J Surg 164:2652681992

10

Danish SFBurnett MGStein SC: Prophylaxis for deep venous thrombosis in patients with craniotomies: a review. Neurosurg Focus 17(4):E22004

11

Dermody MAlessi-Chinetti JIafrati MDEstes JM: The utility of screening for deep venous thrombosis in asymptomatic, non-ambulatory neurosurgical patients. J Vasc Surg 53:130913152011

12

Dickinson LDMiller LDPatel CPGupta SK: Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 43:107410811998

13

Falck-Ytter YFrancis CWJohanson NACurley CDahl OESchulman S: Prevention of VTE in orthopedic surgery patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 141 (2 Suppl):e278Se325S2012

14

Frisius JEbeling MKarst MFahlbusch RSchedel IGerganov V: Prevention of venous thromboembolic complications with and without intermittent pneumatic compression in neurosurgical cranial procedures using intraoperative magnetic resonance imaging. A retrospective analysis. Clin Neurol Neurosurg 133:46542015

15

Galanaud JPQuenet SRivron-Guillot KQuere ISanchez Muñoz-Torrero JFTolosa C: Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost 7:202820342009

16

Gillet JLPerrin MRAllaert FA: Short-term and mid-term outcome of isolated symptomatic muscular calf vein thrombosis. J Vasc Surg 46:5135192007

17

Hamilton MGHull RDPineo GF: Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 34:2802961994

18

Heesen MKemkes-Matthes BDeinsberger WBoldt JMatthes KJ: Coagulation alterations in patients undergoing elective craniotomy. Surg Neurol 47:35381997

19

Jacobs DGPiotrowski JJHoppensteadt DASalvator AEFareed J: Hemodynamic and fibrinolytic consequences of intermittent pneumatic compression: preliminary results. J Trauma 40:7107171996

20

Kakkos SKCaprini JAGeroulakos GNicolaides ANStansby GReddy DJ: Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism in high-risk patients. Cochrane Database Syst Rev 4:CD0052582008

21

Kakkos SKCaprini JAGeroulakos GNicolaides ANStansby GReddy DJ: Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism. Cochrane Database Syst Rev 9:CD0052582016

22

Kearon C: Natural history of venous thromboembolism. Circulation 107 (23 Suppl 1):I22I302003

23

Khaldi AHelo NSchneck MJOrigitano TC: Venous thromboembolism: deep venous thrombosis and pulmonary embolism in a neurosurgical population. J Neurosurg 114:40462011

24

Kurtoglu MYanar HBilsel YGuloglu RKizilirmak SBuyukkurt D: Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin. World J Surg 28:8078112004

25

Masuda EMKistner RL: The case for managing calf vein thrombi with duplex surveillance and selective anticoagulation. Dis Mon 56:6016132010

26

Palareti GCosmi BLessiani GRodorigo GGuazzaloca GBrusi C: Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost 104:106310702010

27

Prandoni PFalanga APiccioli A: Cancer and venous thromboembolism. Lancet Oncol 6:4014102005

28

Prandoni PPiccioli AGirolami A: Cancer and venous thromboembolism: an overview. Haematologica 84:4374451999

29

Prell JRachinger JSmaczny RTaute BMRampp SIllert J: D-dimer plasma level: a reliable marker for venous thromboembolism after elective craniotomy. J Neurosurg 119:134013462013

30

Rachinger JCKoman GScheller CPrell JRampp SStrauss C: Practice in the perioperative prevention of deep vein thrombosis in German neurosurgical departments: is there a trend towards homogenization? Cent Eur Neurosurg 72:1151192011

31

Righini MParis SLe Gal GLaroche JPPerrier ABounameaux H: Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost 95:56642006

32

Roberts VCSabri SBeeley AHCotton LT: The effect of intermittently applied external pressure on the haemodynamics of the lower limb in man. Br J Surg 59:2232261972

33

Silbersack YTaute BMHein WPodhaisky H: Prevention of deep-vein thrombosis after total hip and knee replacement. Low-molecular-weight heparin in combination with intermittent pneumatic compression. J Bone Joint Surg Br 86:8098122004

34

Stein PDMatta FMusani MHDiaczok B: Silent pulmonary embolism in patients with deep venous thrombosis: a systematic review. Am J Med 123:4264312010

35

Urbankova JQuiroz RKucher NGoldhaber SZ: Intermittent pneumatic compression and deep vein thrombosis prevention. A meta-analysis in postoperative patients. Thromb Haemost 94:118111852005

36

Vukovich TCGabriel ASchaeffer BVeitl MMatula CSpiss CK: Hemostasis activation in patients undergoing brain tumor surgery. J Neurosurg 87:5085111997

37

White RHZhou HRomano PS: Incidence of symptomatic venous thromboembolism after different elective or urgent surgical procedures. Thromb Haemost 90:4464552003

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