Tom[a]
AAN: Deep Vein Thrombosis Remains Long-term Risk for Brain Cancer Surgery Patients
By Ed Susman
Special to DG News
DENVER, CO -- April 16, 2002 -- Deep vein thrombosis appears to remain a risk factor for patients undergoing brain cancer surgery despite perioperative DVT prophylaxis, according to data from the Glioma Outcome Project.
The research was presented at the 54th Annual Meeting of the American Academy of Neurology (AAN).
"Malignant glioma patients-particularly those over age 40 --remain at an increased risk of developing deep vein thrombosis even 12 to 15 months following surgery," said Dr. Subramanian Hariharan, MD, assistant professor of neurology and director of neuro-oncology at the Seton Hall University, Edison, NJ.
The Glioma Outcomes Project, an observational database supported by Guilford Pharmaceuticals, enrolled malignant glioma patients who underwent surgery between January 1997 and July 2000. The study reports data gleaned from enrollment of 722 patients by 126 surgeons at 50 North American hospitals. Patients were followed at three-month intervals for up to two years.
Dr. Hariharan said that analyses revealed a continuing risk of developing deep vein thrombosis following hospital discharge, which increased with each 3-month period of survival. For example, the risk of developing deep vein thrombosis -- a major risk factor for stroke or pulmonary embolism -- was about twice normal in the first three months following surgery. It rose to 5.6-fold risk in the 3-6 month period and was 22.9 times normal if the patient survived to the 12-15 month period.
About 80 percent of the patients were treated prophylactically with intermittent pneumatic compression; 70 percent received elastic stockings; low-dose unfractionated heparin was administered to ten percent of the patients and four percent of the patients were given low molecular weight heparin. Intermittent pneumatic compression was offered in combination with an anticoagulant to 11 percent of the patients. Anticoagulant alone was used in one percent of patients.
Dr. Hariharan said that guidelines for treatment of deep vein thrombosis in cancer patients suggest long-term treatment with unfractionated heparin or low molecular weight heparin, Yet patients frequently leave the hospital without prescriptions for these medications, he said.
"Perioperative deep vein thrombosis prophylaxis does not provide long term protection," Dr. Hariharan said during his presentation. And he said that even though well-documented studies demonstrate that deep vein thrombosis prophylaxis is necessary for patients who have undergone craniotomy, their use is sometimes limited to just instruction in using pressure stockings.
The need for some form of prophylaxis is apparently well known by clinicians, Dr. Hariharan said, evidenced by the fact that 86 percent of patients undergoing the surgery had some form of prophylaxis noted in their treatment records.
The median age of subjects in the study was 54 years; 58 percent of the patients were men; and 86 percent were white. In the study cohort, 130 patients underwent a biopsy; 445 patients had their first craniotomy; 147 patients had their second craniotomy. The median length of hospital stay was 4 days -- a figure, he said, that continues to decrease.
Deep vein thrombosis prophylaxis was provided for 73 percent of biopsy patients, 89 percent of first craniotomy patients and 93 percent of second craniotomy patients.