Risk factors for postoperative thrombosis-related complications in patients undergoing malignant brain tumor resection: a retrospective cohort study

Introduction Patients with malignant brain tumors frequently exhibit hypercoagulation and are at a high risk of postoperative thrombosis-related complications. However, the risk factors for postoperative thrombosis-related complications remain unclear. Methods In this retrospective, observational study, we consecutively enrolled elective patients undergoing resection of malignant brain tumors from 26 November 2018 to 30 September 2021. The primary objective of the study was to identify risk factors for a composite of three major adverse events including postoperative lower limb deep venous thrombosis, pulmonary embolism, and cerebral ischemia. Results A total of 456 patients were enrolled in this study, where 112 (24.6%) patients had postoperative thrombosis-related complications, 84 (18.4%) with lower limb deep venous thrombosis, 0 (0.0%) with pulmonary embolism, and 42 (9.2%) with cerebral ischemia. In a multivariate model, age more than 60 years (OR: 3.98, 95% CI: 2.30–6.88, P < 0.001), preoperative abnormal APTT (OR: 2.81, 95% CI: 1.06–7.42, P = 0.037), operation duration longer than 5 h (OR: 2.36, 95% CI: 1.34–4.16, P = 0.003), and admission to ICU (OR: 2.49, 95% CI: 1.21–5.12, P = 0.013) were independent risk factors of the postoperative deep vein thrombosis. Intraoperative plasma transfusion (OR: 6.85, 95% CI: 2.73–17.18, P < 0.001) was associated with significantly increased odds of deep vein thrombosis. Conclusion Patients with craniocerebral malignant tumors have a high incidence of postoperative thrombosis-related complications. There is an increase in the odds of postoperative lower limb deep venous thrombosis in patients; over 60 years old, with preoperative abnormal APTT, undergoing surgeries longer than 5-h, admission to ICU, or receiving intraoperative plasma infusion. Fresh frozen plasma infusion should be used more cautiously, especially in patients with a high risk of thrombosis.

[1]  S. Currie,et al.  Do animal models of brain tumors replicate human peritumoral edema? a systematic literature search , 2023, Journal of Neuro-Oncology.

[2]  O. Solheim,et al.  Brain infarction following meningioma surgery—incidence, risk factors, and impact on function, seizure risk, and patient-reported quality of life , 2022, Neurosurgical Review.

[3]  Shu-hai Shi,et al.  Incidence, and preoperative and intraoperative prognostic factors of deep venous thrombosis in patients with glioma following craniotomy , 2021, Clinical Neurology and Neurosurgery.

[4]  D. Bouget,et al.  Brain infarctions after glioma surgery: prevalence, radiological characteristics and risk factors , 2021, Acta Neurochirurgica.

[5]  Baoguo Wang,et al.  Preoperative and intraoperative predictors of deep venous thrombosis in adult patients undergoing craniotomy for brain tumors: A Chinese single-center, retrospective study. , 2020, Thrombosis research.

[6]  B. Meyer,et al.  Metabolic Parameters Influence Brain Infarction and Outcome after Resection of Brain Metastases , 2020, Cancers.

[7]  C. Flowers,et al.  Venous Thromboembolism Prophylaxis and Treatment in Patients With Cancer: ASCO Clinical Practice Guideline Update. , 2020, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Thara Tunthanathip,et al.  Postoperative Venous Thromboembolism in Extramedullary Spinal Tumors , 2020, Asian journal of neurosurgery.

[9]  Z. Ram,et al.  Incidence and impact of stroke following surgery for low-grade gliomas. , 2019, Journal of neurosurgery.

[10]  M. Ghosh,et al.  The interrelationship between cerebral ischemic stroke and glioma: a comprehensive study of recent reports , 2019, Signal Transduction and Targeted Therapy.

[11]  R. Kandasamy,et al.  Deep Vein Thrombosis and the Neurosurgical Patient , 2019, The Malaysian journal of medical sciences : MJMS.

[12]  C. Hesse,et al.  Effects of fibrinogen and platelet transfusion on coagulation and platelet function in bleeding cardiac surgery patients , 2018, Acta anaesthesiologica Scandinavica.

[13]  Timothy R. Smith,et al.  Thirty-Day Outcomes After Craniotomy for Primary Malignant Brain Tumors: A National Surgical Quality Improvement Program Analysis , 2018, Neurosurgery.

[14]  A. Alexandrov,et al.  Prediction of Delayed Cerebral Ischemia with Cerebral Angiography: A Meta-Analysis , 2018, Neurocritical Care.

[15]  Yuehua Wu,et al.  Coagulation Alteration and Deep Vein Thrombosis in Brain Tumor Patients During the Perioperative Period. , 2018, World neurosurgery.

[16]  Fumi Nakano,et al.  Incidence and risk factor of deep venous thrombosis in patients undergoing craniotomy for brain tumors: A Japanese single-center, retrospective study. , 2018, Thrombosis research.

[17]  J. Senders,et al.  Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis , 2017, Journal of Neuro-Oncology.

[18]  M. Murphy,et al.  Blood transfusion: summary of NICE guidance , 2015, BMJ : British Medical Journal.

[19]  A. Khorana,et al.  Venous thromboembolism in patients with glioblastoma: Risk factors and prognostic importance. , 2015 .

[20]  M. Gilbert,et al.  Venous thromboembolism (VTE) and glioblastoma , 2015, Journal of Neuro-Oncology.

[21]  Timothy R. Smith,et al.  Development of venous thromboembolism (VTE) in patients undergoing surgery for brain tumors: Results from a single center over a 10year period , 2015, Journal of Clinical Neuroscience.

[22]  A. Jakola,et al.  Surgically Acquired Deficits and Diffusion Weighted MRI Changes after Glioma Resection - A Matched Case-Control Study with Blinded Neuroradiological Assessment , 2014, PloS one.

[23]  E. Horváth-Puhó,et al.  Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study. , 2013, JAMA internal medicine.

[24]  C. Zimmer,et al.  Postoperative ischemic changes following resection of newly diagnosed and recurrent gliomas and their clinical relevance. , 2013, Journal of neurosurgery.

[25]  Christopher M. Jackson,et al.  Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors , 2013, Neurological research.

[26]  Xing Chen,et al.  [Impact of hemocoagulase on coagulatory function and deep venous thrombosis after abdominal surgery]. , 2012, Zhonghua wei chang wai ke za zhi = Chinese journal of gastrointestinal surgery.

[27]  T. Zeller,et al.  Summary of NICE guidance , 2011, Heart.

[28]  M. Wintermark,et al.  Neuroimaging of Cerebral Ischemia and Infarction , 2011, Neurotherapeutics.

[29]  F. Schmidt.  Meta-Analysis , 2008 .

[30]  S. Pocock,et al.  Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies , 2007, BMJ : British Medical Journal.

[31]  K. Meehan,et al.  The coagulation system as a target for the treatment of human gliomas. , 2002, Seminars in thrombosis and hemostasis.

[32]  Timothy R. Smith,et al.  145 Unplanned Reoperation After Craniotomy for Tumor: A National Surgical Quality Improvement Program Analysis. , 2016, Neurosurgery.

[33]  Hanna Somatic,et al.  Principles and Practices , 2014 .

[34]  Hsien-Ho Lin,et al.  A nationwide, population-based, case-control study , 2012 .

[35]  S. Pocock,et al.  Guidelines for Reporting Observational Studies , 2007 .