Chemical venous thromboembolism prophylaxis in neurosurgical patients

An updated systematic review and meta-analysis

Nickalus R. Khan, Prayash G. Patel, John P. Sharpe, Siang Liao Lee, Jeffrey Sorenson

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

OBJECTIVE Venous thromboembolism (VTE) is a common and potentially life-threatening complication. The risk of serious hemorrhagic complications when starting chemical prophylaxis for VTE prevention is a substantial concern for neurosurgeons. The objective of this study was to perform an updated systematic review and meta-analysis to determine if the rates of VTE and bleeding complications are different in patients undergoing chemoprophylaxis compared with placebo or mechanical prophylaxis alone following cranial or spinal procedures. METHODS In February 2016 a systematic literature review was performed identifying 3944 articles from 4 different databases. A random-effects meta-analysis was performed after identifying the articles that met inclusion criteria. RESULTS Nine articles that met the inclusion criteria were included. The quality of the studies was good, with all of them being classified as Level 2 evidence, with moderate Jadad scores. A meta-analysis comparing chemoprophylaxis with placebo in the prevention of deep venous thrombosis showed a significant benefit to chemical prophylaxis (OR 0.51, 95% CI 0.37-0.71; p < 0.0001). No significant increase in major intracranial hemorrhage (p = 0.60), major extracranial hemorrhage (p = 0.98), or minor bleeding complications (p = 0.60) was found. CONCLUSIONS Based on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.

Original languageEnglish (US)
Pages (from-to)906-915
Number of pages10
JournalJournal of neurosurgery
Volume129
Issue number4
DOIs
StatePublished - Oct 1 2018

Fingerprint

Venous Thromboembolism
Meta-Analysis
Chemoprevention
Hemorrhage
Placebos
Intracranial Hemorrhages
Venous Thrombosis
Databases
Research

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Chemical venous thromboembolism prophylaxis in neurosurgical patients : An updated systematic review and meta-analysis. / Khan, Nickalus R.; Patel, Prayash G.; Sharpe, John P.; Lee, Siang Liao; Sorenson, Jeffrey.

In: Journal of neurosurgery, Vol. 129, No. 4, 01.10.2018, p. 906-915.

Research output: Contribution to journalReview article

Khan, Nickalus R. ; Patel, Prayash G. ; Sharpe, John P. ; Lee, Siang Liao ; Sorenson, Jeffrey. / Chemical venous thromboembolism prophylaxis in neurosurgical patients : An updated systematic review and meta-analysis. In: Journal of neurosurgery. 2018 ; Vol. 129, No. 4. pp. 906-915.
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abstract = "OBJECTIVE Venous thromboembolism (VTE) is a common and potentially life-threatening complication. The risk of serious hemorrhagic complications when starting chemical prophylaxis for VTE prevention is a substantial concern for neurosurgeons. The objective of this study was to perform an updated systematic review and meta-analysis to determine if the rates of VTE and bleeding complications are different in patients undergoing chemoprophylaxis compared with placebo or mechanical prophylaxis alone following cranial or spinal procedures. METHODS In February 2016 a systematic literature review was performed identifying 3944 articles from 4 different databases. A random-effects meta-analysis was performed after identifying the articles that met inclusion criteria. RESULTS Nine articles that met the inclusion criteria were included. The quality of the studies was good, with all of them being classified as Level 2 evidence, with moderate Jadad scores. A meta-analysis comparing chemoprophylaxis with placebo in the prevention of deep venous thrombosis showed a significant benefit to chemical prophylaxis (OR 0.51, 95{\%} CI 0.37-0.71; p < 0.0001). No significant increase in major intracranial hemorrhage (p = 0.60), major extracranial hemorrhage (p = 0.98), or minor bleeding complications (p = 0.60) was found. CONCLUSIONS Based on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.",
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N2 - OBJECTIVE Venous thromboembolism (VTE) is a common and potentially life-threatening complication. The risk of serious hemorrhagic complications when starting chemical prophylaxis for VTE prevention is a substantial concern for neurosurgeons. The objective of this study was to perform an updated systematic review and meta-analysis to determine if the rates of VTE and bleeding complications are different in patients undergoing chemoprophylaxis compared with placebo or mechanical prophylaxis alone following cranial or spinal procedures. METHODS In February 2016 a systematic literature review was performed identifying 3944 articles from 4 different databases. A random-effects meta-analysis was performed after identifying the articles that met inclusion criteria. RESULTS Nine articles that met the inclusion criteria were included. The quality of the studies was good, with all of them being classified as Level 2 evidence, with moderate Jadad scores. A meta-analysis comparing chemoprophylaxis with placebo in the prevention of deep venous thrombosis showed a significant benefit to chemical prophylaxis (OR 0.51, 95% CI 0.37-0.71; p < 0.0001). No significant increase in major intracranial hemorrhage (p = 0.60), major extracranial hemorrhage (p = 0.98), or minor bleeding complications (p = 0.60) was found. CONCLUSIONS Based on moderate-to-good quality of evidence, chemoprophylaxis is beneficial in preventing VTE, with no significant increase in either major or minor bleeding complications in patients undergoing cranial and spinal procedures. Further research is needed to determine whether this conclusion holds true for more specific subpopulations.

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