Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors
Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors
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DOI：
10.1097/00006123-199811000-00039
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发表时间：
1998-11-01
期刊：
影响因子：
4.8
通讯作者：
Gupta, SK
中科院分区：
文献类型：
--
作者：
Dickinson, LD;Miller, LD;Gupta, SK
目的：预防治疗在降低神经外科患者深静脉血栓形成(DVT)发生率方面已被证明是有效的。对密歇根大学神经外科手术患者的回顾分析显示，在仅接受顺序加压装置(SCD)预防的颅内肿瘤患者中，术后DVT的发生率很高(14%)。因此，我们研究了低分子肝素依诺肝素预防脑肿瘤患者DVT的有效性和安全性。这项研究的目的是比较SCD、依诺肝素以及SCD/依诺肝素联合预防在需要手术治疗颅内肿瘤的患者中的作用。方法：符合条件的患者随机分为SCD、依诺肝素或联合治疗。治疗在麻醉诱导之前开始，并在整个住院期间持续进行。在术后1个月内，使用双功能成像对患者进行了四次DVT筛查。用方差分析和Dunnet双侧t检验比较两组间DVT和严重不良事件的发生率。结果：68例患者完成研究。术后DVT发生率分别为3/22(13.6%)、1/23(4.3%)和4/23(17.4%)。差异在统计学上没有显著意义。SCD治疗组患者术后未发生颅内出血，而接受低分子肝素治疗的46例患者中有5例发生了临床上显著的颅内出血。由于依诺肝素组不良事件发生率增加，研究终止。结论：麻醉诱导时开始依诺肝素治疗会增加术后颅内出血。
OBJECTIVE: Prophylactic therapies have demonstrated efficacy in reducing the incidence of deep venous thrombosis (DVT) in neurosurgical patients. Retrospective analysis of patients undergoing neurosurgical procedures at the University of Michigan demonstrated a high incidence (14%) of postoperative DVT among patients with intracranial neoplasms treated with sequential compression device (SCD) prophylaxis alone. Therefore, we investigated the efficacy and safety of the low-molecular weight heparin enoxaparin in preventing DVT in patients with brain tumors. The goal of the study was to compare SCD, enoxaparin, and combined SCD/enoxaparin prophylaxis among patients requiring surgery for treatment of intracranial neoplasms.METHODS: Eligible patients were randomized to SCD, enoxaparin, or combined therapy. Treatment was initiated before the induction of anesthesia and was continued throughout the hospital stay. Patients were screened for DVT, using duplex imaging, on four occasions in the first 1 month after surgery. The incidences of DVT and serious adverse events were compared between groups using analysis of variance and the Dunnet two-sided t test.RESULTS: Sixty-eight patients completed the study. Postoperative DVT occurred in 3 of 22 (13.6%) SCD-treated patients, 1 of 23 (4.3%) enoxaparin-treated patients, and 4 of 23 (17.4%) SCD/enoxaparin-treated patients. Differences were not statistically significant. Postoperative intracranial hemorrhage did not occur in patients in the SCD-treated group, whereas 5 of 46 patients receiving low-molecular weight heparin suffered clinically significant intracranial hemorrhage. The study was terminated because of the increased incidence of adverse events in the enoxaparin-treated groups.CONCLUSION: Enoxaparin therapy initiated at the time of anesthesia induction increases postoperative intracranial hemorrhage.