Goldhaber SZ, Dunn K, Gerahrd-Herman M, Park JK, Black PM.
Low rate of venous thromboembolism after craniotomy for brain tumor using
multimodality prophylaxis.
Chest 2002 Dec;122(6):1933-7

Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, 75
Francis Street, Boston, MA 02115, USA. sgoldhaber@partners.org

CONTEXT: Venous thromboembolism (VTE) is the most frequent complication following
craniotomy for brain tumors. At Brigham and Women's Hospital, VTE after
craniotomy for brain tumor is the leading cause of deep vein thrombosis (DVT) and
pulmonary embolism (PE) among patients hospitalized for conditions other than
VTE. OBJECTIVE: To minimize VTE among patients undergoing craniotomy for brain
tumor. DESIGN: Randomized, prospective, double-blind clinical trial. SETTING:
Brigham and Women's Hospital. PATIENTS: One hundred fifty patients undergoing
craniotomy for brain tumor randomized to enoxaparin, 40 mg/d, vs heparin, 5,000 U
bid, with all patients receiving graduated compression stockings and intermittent
pneumatic compression. MAIN OUTCOME MEASURES: The rate of DVT detected by venous
ultrasonography prior to hospital discharge. RESULTS: Symptomatic DVT or PE
developed in none of the patients. The overall rate of asymptomatic VTE was 9.3%,
with no significant difference in the rates between the two prophylaxis groups.
Ten of the 14 patients identified with VTE had thrombus limited to the deep veins
of the calf. CONCLUSIONS: Enoxaparin, 40 mg/d, or unfractionated heparin, 5,000 U
bid, in combination with graduated compression stockings, intermittent pneumatic
compression, and predischarge surveillance venous ultrasonography of the legs,
resulted in 150 consecutive patients without symptomatic VTE. The low 9.3%
frequency of asymptomatic VTE comprised mostly isolated calf DVT. Therefore, this
comprehensive, multimodality approach to VTE prophylaxis achieved excellent
efficacy and safety.