Advance Access: Systematic Review of Safety and Cost-Effectiveness of Venous Thromboembolism Prophylaxis Strategies in Patients Undergoing Craniotomy for Brain Tumor

Venous thromboembolism (VTE) is a common neurosurgical complication and its prophylaxis has been widely studied.1Recommendations for prophylaxis in neurosurgery patients are variable.2,3 Rates of deep vein thrombosis (DVT) and pulmonary embolism (PE) in neurosurgical patients range from 0% to 34% and 0% to 3.8%, respectively.4,5 Brain tumors are classically associated with increased VTE risk68; rates of symptomatic DVT in the first 6 wk postop may be as high as 24%.8 Thirty percent of patients with malignant glioma may develop VTE within 12 mo.5,8,9 The main strategies for prophylaxis are mechanical prophylaxis (MP), including intermittent pneumatic compression (IPC) and/or graduated compression stockings (GCS), low molecular weight heparin (LMWH) and unfractionated heparin (UFH). The risk of hemorrhage due to anticoagulation is widely reported.10 The American College of Chest Physicians (ACCP) guidelines currently recommend the use of either anticoagulants or IPC/GCS based on a patient’s overall risk profile.2

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