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Venous thromboembolism chemical prophylaxis after skull base surgery
Mueez Waqar1,2, Omar Yaseen1, Annabel Chadwick1,2
1Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Northern Care Alliance NHS Foundation Trust, Salford, UK.
Acta Neurochirurgica
|April 2, 2024
Summary
Postoperative chemoprophylaxis is relatively safe for skull base surgery patients, with no significant increase in intracranial haematoma risk. Early administration (days 1-2) is recommended when indicated.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Pharmacology
Background:
- Lack of established guidelines for venous thromboembolism (VTE) prophylaxis in skull base surgery.
- Need to evaluate the safety and efficacy of pharmacological agents (chemoprophylaxis) in this patient population.
Purpose of the Study:
- To compare VTE and intracranial haematoma rates in patients undergoing skull base surgery with and without chemoprophylaxis.
- To identify factors influencing VTE and intracranial haematoma occurrence post-surgery.
Main Methods:
- Retrospective review of a prospective database (2009-2020) of adult patients undergoing first-time skull base surgery.
- Definition of VTE as deep vein thrombosis (DVT) or pulmonary embolism (PE) within 6 months.
- Multivariate logistic regression and propensity score matching (PSM) for group comparisons.
Main Results:
- 1551 patients included; 81% received chemoprophylaxis starting median day 1 postoperatively.
- 1.2% VTE events observed; chemoprophylaxis did not eliminate risk, with higher incidence after postoperative day 6.
- 0.8% intracranial haematomas; PSM showed chemoprophylaxis did not significantly increase risk. Early (days 1-2) prophylaxis showed similar safety and efficacy.
Conclusions:
- Postoperative chemoprophylaxis is a generally safe strategy for skull base surgery.
- A personalized approach to chemoprophylaxis is advocated.
- Recommend initiating chemoprophylaxis on postoperative days 1 or 2 if indicated.
