Article
Comparison of certoparine, enoxaparine and compression stockings for thromboembolic prophylaxis in neurosurgical practice
Vergleich von Certoparin, Enoxaparin und Kompressionsstrümpfen zur thrombembolischen Prophylaxe bei neurochirurgischen Patienten
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Authors
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Witold Polanski
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Dietmar Krex
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
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Gabriele Schackert
- Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Neurochirurgie, Dresden, Deutschland
| Published: | May 8, 2019 |
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Outline
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Objective: Postoperative thromboembolic events are a serious surgical complication and results most often in morbidity and mortality. In neurosurgical patients, the risk for venous thromboembolisms (VTE), including pulmonary embolism (PE) and deep venous thrombosis (DVT), is very high (range 0 to 5%) due to long surgical procedures, long immobilization, possible neurological deficits and hypercoagulability induced by neoplasms and subarachnoidal bleedings. In a recent meta-analysis, certoparine and enoxaparine were similar in preventing PE and DVT after general surgery, whereas neurosurgical procedures were not considered. We compared the incidence of thromboembolic events in neurosurgical practice under prophylaxis with enoxaparine with compression stockings and certoparine with and without compression stockings.
Methods: From 2014–2017, 6667 neurosurgical patients, which underwent surgery, were recorded and symptomatic thromboembolic events with associated diagnosis, procedure and patient characteristics were registered and analyzed.
Results: Out of 3295 patients, which received a prophylaxis with enoxaparine and compression stockings, 18 patients suffered postoperatively from a symptomatic VTE (0.55%). Five of these patients had been operated because of intracerebral (ICB) or subarachnoidal bleedings (SAB), 4 patients because of a meningioma, 3 patients because of spinal degeneration, 6 patients because of other tumors. 1681 patients received a prophylaxis with certoparine and compression stockings, from which 17 symptomatic VTE were recorded (1.01%). Four patients were operated because of a meningioma, 4 patients suffered from ICB, 3 patients were treated because of metastasis, 4 because of a glioma and 2 patients because of spinal degeneration. 1691 patients were treated with certoparine without compression stockings with 16 recorded symptomatic VTE (0.95%). Out of these patients, 5 patients suffered from a glioma, 4 patients received a tumorexstirpation of a meningioma, 3 patients were treated because of a SAB and 4 patients suffered from other tumors.
Conclusion: In contrast to recent findings, enoxaparine seems to be superior to certoparine in preventing VTE in neurosurgical practice, while compression stockings have no influence on the risk of VTE.
