gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Therapeutic anticoagulation following craniotomies: is the risk for secondary bleeding overrated?

Meeting Abstract

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  • C. Scheller - Neurochirurgische Klinik und Poliklinik der Universität Halle-Wittenberg
  • C. Strauss - Neurochirurgische Klinik und Poliklinik der Universität Halle-Wittenberg

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.17.07

DOI: 10.3205/12dgnc159, URN: urn:nbn:de:0183-12dgnc1593

Published: June 4, 2012

© 2012 Scheller et al.
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Outline

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Objective: 43 patients suffering from pulmonary embolism and/or deep venous thrombosis following craniotomy were retrospectively analysed. Therapeutic anticoagulation was performed with enoxaparin (30–100 mg), certoparin (3000 i.e.) or heparin (according to PTT levels). Indications for surgery were meningeomas (n = 18), acoustic neuromas (n = 8), aneurysms (n = 5), gliomas (n = 4), subdural hematomas (n = 3), ependymoma (n = 1), hemangioblastoma (n = 1), brain metastases (n = 1), prolactinoma (n = 1) and intracerebral hemorrhage (n = 1).

Methods: The time between the surgical procedure and the diagnosis of pulmonary embolism and/or severe venous thrombosis was documented. In addition, the administered medication and its dosage were analysed regarding patients' weight, kidney and liver functions. Secondary bleeding was excluded either by clinical uneventful course or by cranial CT.

Results: None of the patients developed a secondary bleeding. Pulmonary embolism and/or severe venous thrombosis were recognized between the first and the 27th postoperative day (mean: fifth postoperative day) resulting in a start of anticoagulation from the first to the 28th postoperative day (mean: sixth postoperative day). There were wide variations in the applied active substances and their dosage. Full heparinisation was performed in 21 patients between the third and the 30th postoperative day (mean: 12th postoperative day).

Conclusions: The observed wide differences in the active substances used, the start of medication and its dosage reflect that a standardized protocol concerning the treatment of postoperative pulmonary embolism and/or deep venous thrombosis following craniotomy is lacking. Considering that there was no secondary bleeding in this study and that pulmonary embolism and/or deep venous thrombosis are potentially life-threatening complications, it may be justified to be more aggressive in the application of anticoagulative drugs following craniotomy.