Artikel
Venous thromboembolic events are more frequent in high grade then in low grade glioma patients
Thrombembolische Ereignisse treten häufiger in hochgradigen als in niedriggradigen Gliomen auf
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Autoren
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Á. Oszvald
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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R. Gerlach
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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V. Seifert
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
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K. Franz
- Klinik für Neurochirurgie, Johann-Wolfgang-Goethe-Universität, Frankfurt/Main
| Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: To review the incidence of venous thromboembolic (TE) events in cerebral glioma patients.
Methods: The data for this study derive from a large prospectively conducted data base of cerebral gliomas with regular follow-up from diagnosis to death. 75 patients (male:femal; 40:35) initially diagnosed with cerebral glioma from October 2005 through October 2006 were included. All patients underwent either microsurgical removal or biopsy. 47 patients (median 67y) with WHO °IV, 12 patients (median 45.5y) with WHO °III, 13 patients (median 40y) with WHO °II and 3 patients (median 45y) with WHO °I gliomas were treated during this year. Venous thromboembolism (TE) prophylaxis was performed with antithromboembolism (AT) stockings and Nadroparin sc 0.3 ml/d from day 1 postoperative until discharge. Clinically minor or unspecific symptoms (diffuse lower leg pain, slight fever and general condition worsening) led to analysis of D-Dimere (parameter of activated coagulation). Thrombosis (DVT) and/or pulmonary artery embolism (PE) was suspected in case of a rise of D-Dimere and had been verified by Duplex Sonography and CT thorax or autopsy.
Results: 11 of 47 patients (23%) with a WHO°IV glioma and 4 of 12 patients with a WHO°III glioma (33.3%) developed a DVT or PE. Among the 16 patients with low grade gliomas no DVT or PE was observed. 36% of the WHO°IV and 100% of the WHO°III patients with TE events developed them during the perioperative period, whereas 64% (7/11) of the WHO°IV patients developed TE events during the course of disease.
Conclusions: In high grade gliomas the occurrence of DVT or PE ranges between 23% and 33%, compared to none in low grade gliomas. Although a rigorous prophylaxis (AT-stockings and nadroparin) has been consequently performed, a surprisingly high number of TE events have been observed. Since apparative diagnostic screening procedures are not performed routinely, a more attentive clinical observation should discover unspecific symptoms and lead to immediate diagnostic procedure. With regard to our results TE prophylaxis during the course of disease needs to be discussed.
