Prophylactic use of anticoagulation and hemodilution for the prevention of venous thromboembolic events following meningioma surgery

• Meningioma has a high incidence of postoperative venous thromboembolic events.
• High incidence of venous thrombosis is associated with usual prophylactic measures.
• Hemodilution was done by normal saline infusion starting at the onset of surgery.
• Anticoagulation was done by enoxaparin injection starting 12 h after surgery.
• Combining hemodilution and anticoagulation reduced postoperative thromboembolism.

ObjectivesBrain tumors may be associated with postoperative venous thromboembolic (VTE) events with possible devastating consequences. Meningioma has the highest incidence of postoperative VTE events among all brain tumors. Hemodilution and anticoagulation both proved efficacy in deep venous thrombosis (DVT) prophylaxis that is why we theorized that this regimen would be beneficial for VTE prophylaxis in operated intracranial meningioma patients without added risk to the patients.Patients and methodsA retrospective double-blinded study, where the records of consecutive intracranial meningioma patients were revised comparing the efficacy of two regimens of postoperative VTE prophylaxis. Patients were divided into 2 groups; group A was submitted to the use of compressive stockings, low-molecular weight heparin (LMWH) administration and hemodilution, while group B was submitted only to the use of compressive stockings.ResultsThe study included 194 patients. Mean age of patients was 55 years (range from 27 to 78 years). VTE events were diagnosed in 16 patients (8.2%) all of them belonged to group B. The median time for VTE events was 12 days. Older age (P = .0001), larger size tumor (p = 0.0438), delayed ambulation postoperatively (p = 0.0351) as well as skull base location of meningioma (p = 0.0163) were associated with higher incidence of postoperative VTE. Overall, group A patients showed more favorable outcome as compared to group B.ConclusionIn addition to the use of elastic stockings, we recommend starting hemodilution at the outset of surgery, LMWH administration starting 12 h postoperatively as well as refraining from the use of diuretics during and after intracranial meningioma surgery till the patient became fully ambulatory to reduce the incidence of postoperative VTE events.