gms | German Medical Science

Objective: Anticoagulation (AC) is a critical topic in perioperative and post-bleeding management. Yet, there is a lack of data for a safe and reasonable use of prophylactic and therapeutic anticoagulation in regard of risk factors, cause and modality of brain tissue damage as well as for unfavorable outcomes, such as postoperative hemorrhage (PH) and thromboembolic events (TEE) in neurosurgical patients. In this paper we present retrospective data on perioperative anticoagulation in meningioma surgery.

Methods: Patient data of 286 individuals undergoing meningioma surgery between 2006 and 2018 were analyzed. We followed up on anticoagulation management, doses and time points of first application, laboratory values and adverse events like PH or TEE. Preexisting medication and hemostatic conditions were evaluated. Time course of patients measured as overall survival,re-admission for 30 days after surgery as well as Glasgow Outcome Scale (GOS) and Modified Rankin Scale (mRS). Statistical analysis was performed using multivariate regression.

Results: We carried out AC with Fraxiparin and, since 2015, Tinzaparin in weight-adapted recommended prophylactic doses. Delayed (216 ± 228 h) AC was associated with a significantly increased rate of thromboembolic events (p= 0.026). Early (29 ± 21.9 h) prophylactic AC, on the other hand, did not increase the risk of PH. We identified additional risk factors for PH, such as blood pressure maxima, steroid treatment and increased white blood cell count. Patients’ outcome was affected more adversely by TEE than PH (+3 points in modified rankin scale in TEE vs. +1 point in PH, p=0,001).

Conclusion: Early prophylactic AC is not associated with an increased rate of PH. The risks of TEE seem to outweigh those of PH. Early postoperative prophylactic AC in patients undergoing intracranial meningioma resection should be considered.

Table 1 [Tab. 1]

Table 2 [Tab. 2]