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PE in neurosurgery

Joshua Lampert, Behnood Bikdeli, Philip Green, Matthew R Baldwin
While trials of systemic thrombolysis for submassive and massive pulmonary embolism (PE) report intracranial haemorrhage (ICH) rates of 2%-3%, the risk of ICH in patients with recent brain surgery or intracranial neoplasm is unknown since these patients were excluded from these trials. We report a case of massive PE treated with systemic thrombolysis in a patient with recent neurosurgery for an intracranial neoplasm. We discuss the risks and benefits of systemic thrombolysis for massive PE in the context of previous case reports, prior cohort studies and trials, and current guidelines...
November 29, 2017: BMJ Case Reports
Salvatore Chibbaro, Helene Cebula, Julien Todeschi, Marco Fricia, Doris Vigouroux, Houssem Abid, Houssen Kourbanhoussen, Raoul Pop, Beniamino Nannavecchia, Arthur Gubian, Lara Prisco, Gianfranco K I Ligarotti, Francois Proust, Mario Ganau
BACKGROUND: The incidence of venous thromboembolism (VT) in neurosurgical practice is astonishingly high, representing a major cause of morbidity and mortality. Prophylaxis strategies include elastic stockings, low-molecular-weight heparin (LMWH), and intermittent pneumatic compression (IPC) devices. OBJECTIVE: To assess the safety and efficacy of 2 different VT prophylaxis protocols implemented in a European neurosurgical center. METHODS: All patients admitted for neurosurgical intervention between 2012 and 2016 were stratified as low, moderate, and high risk of VT and received a combination of elastic stockings and LMWH...
January 2018: World Neurosurgery
Sukanya Bhunia, Venugopal Vangala, Dwaipayan Bhattacharya, Halley Gora Ravuri, Madhusudana Kuncha, Sumana Chakravarty, Ramakrishna Sistla, Arabinda Chaudhuri
Despite significant progress in neurosurgery and radiation therapy during the past decade, overall survivability (OS) of glioblastoma patients continues to be less than 2 years. The scope of systemic chemotherapy is greatly limited by poor drug transport across the blood brain barrier (BBB) and, thereby, suboptimal drug accumulation in glioma tissue. To this end, use of large amino acid transporter-1 (LAT1) overexpressed both on brain capillary endothelial cells (BCECs) and glioma cells has begun. Prior reports on the use of LAT1 mediated delivery of model drugs showed their brain accumulations...
November 6, 2017: Molecular Pharmaceutics
Mario Ganau, Lara Prisco, Helene Cebula, Julien Todeschi, Houssem Abid, Gianfranco Ligarotti, Raoul Pop, Francois Proust, Salvatore Chibbaro
OBJECTIVE: To analytically discuss some protocols in Deep vein thrombosis (DVT)/pulmonary Embolism (PE) prophylaxis currently use in Neurosurgical Departments around the world. DATA SOURCES: Analysis of the prophylaxis protocols in the English literature: An analytical and narrative review of literature concerning DVT prophylaxis protocols in Neurosurgery have been conducted by a PubMed search (back to 1978). DATA EXTRACTION: 80 abstracts were reviewed, and 74 articles were extracted...
November 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
Xuan Wang, Ying-Chun Zhou, Wen-De Zhu, Yun Sun, Peng Fu, De-Qiang Lei, Hong-Yang Zhao
The aim of this meta-analysis was to examine the risk of postoperative bleeding and efficacy of heparin for preventing deep vein thrombosis (DVT) and pulmonary embolism (PE) in adult patients undergoing neurosurgery. MEDLINE, Cochrane, and EMBASE databases were searched until October 31, 2016, for randomized controlled trials (RCTs) and non-randomized comparative studies that assessed the rates of postoperative hemorrhage, DVT, PE, and mortality in adult patients undergoing neurosurgery. Nine eligible studies (five RCTs, four retrospective studies) including 874 patients treated with either unfractionated heparin (UFH) or low-molecular-weight heparin (LMWH) and 1033 patients in control group (placebo with or without compression device) were analyzed...
July 26, 2017: Journal of Investigative Medicine: the Official Publication of the American Federation for Clinical Research
Fatma Yildirim, Filiz Sadi Aykan
No abstract text is available yet for this article.
2018: Turkish Neurosurgery
James P Byrne, Stephanie A Mason, David Gomez, Christopher Hoeft, Haris Subacius, Wei Xiong, Melanie Neal, Farhad Pirouzmand, Avery B Nathens
BACKGROUND: Patients with severe traumatic brain injury (sTBI) are at high risk for developing venous thromboembolism (VTE). Nonetheless, pharmacologic VTE prophylaxis is often delayed out of concern for precipitating extension of intracranial hemorrhage (ICH). The purpose of this study was to compare the effectiveness of early vs late VTE prophylaxis in patients with sTBI, and to characterize the risk of subsequent ICH-related complication. STUDY DESIGN: Adults with isolated sTBI (head Abbreviated Injury Scale score ≥3 and total Glasgow Coma Scale score ≤8) who received VTE prophylaxis with low-molecular-weight or unfractionated heparin were derived from the American College of Surgeons Trauma Quality Improvement Program (2012 to 2014)...
October 2016: Journal of the American College of Surgeons
Scott A Shapiro, Ian Kainoa White
INTRODUCTION: Patients with symptomatic thrombophilia are treated with therapeutic anticoagulation. These patients can require neurosurgery. The patient must have their anticoagulation reversed before, during, and after surgery. After surgery they must be anticoagulated again. This entails a risk of embolic and hemorrhagic complications. Eighty-seven of these patients underwent neurosurgery between 2003 and 2015. Forty-two had a retrievable inferior vena cava filter before surgery and 45 had no filter placed...
August 2016: Neurosurgery
R Michael Meyer, M Benjamin Larkin, Nicholas S Szuflita, Chris J Neal, Jeffrey M Tomlin, Rocco A Armonda, Jeffrey A Bailey, Randy S Bell
OBJECTIVE Traumatic brain injury (TBI) is independently associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). Given the numerous studies of civilian closed-head injury, the Brain Trauma Foundation recommends venous thromboembolism chemoprophylaxis (VTC) after severe TBI. No studies have specifically examined this practice in penetrating brain injury (PBI). Therefore, the authors examined the safety and effectiveness of early VTC after PBI with respect to worsening intracranial hemorrhage and DVT or PE...
April 2017: Journal of Neurosurgery
Robert C Neely, John G Byrne, Igor Gosev, Lawrence H Cohn, Quratulain Javed, James D Rawn, Samuel Z Goldhaber, Gregory Piazza, Sary F Aranki, Prem S Shekar, Marzia Leacche
BACKGROUND: Pulmonary embolectomy is often indicated for central pulmonary embolism (PE) with hemodynamic instability, but remains controversial for hemodynamically stable patients with signs of right ventricular dysfunction. Because thrombolytic therapy is often contraindicated postoperatively, we reviewed risk factors and outcomes of pulmonary embolectomy for stable and unstable central PE, particularly in the early postoperative period. METHODS: Between October 1999 and September 2013, 115 patients underwent pulmonary embolectomy for central, hemodynamically unstable PE (49 of 115, 43%) or hemodynamically stable PE (56 of 115, 49%)...
October 2015: Annals of Thoracic Surgery
Lauren P Cote, Steven Greenberg, Joseph A Caprini, James Stone, Juan I Arcelus, Luciano López-Jiménez, Vladimir Rosa, Sebastian Schellong, Manuel Monreal
OBJECTIVES: Registro Informatizado de Enfermedad TromboEmbólica (RIETE) database was used to investigate whether neurosurgical patients with venous thromboembolism (VTE) were more likely to die of bleeding or VTE and the influence of anticoagulation on these outcomes. METHODS: Clinical characteristics, treatment details, and 3-month outcomes were assessed in those who developed VTE after neurosurgery. RESULTS: Of 40 663 patients enrolled, 392 (0...
November 2014: Clinical and Applied Thrombosis/hemostasis
Michael Safaee, Matthew Z Sun, Taemin Oh, Manish K Aghi, Mitchel S Berger, Michael W McDermott, Andrew T Parsa, Orin Bloch
OBJECTIVE: Hemostatic agents are widely used in patients undergoing intracranial tumor resection to facilitate local hemostasis. We hypothesized that systemic activation of the clotting cascade after local application of hemostatic agents may result in unintended thromboembolic events, including deep venous thrombosis (DVT) and pulmonary embolism (PE). We performed a retrospective analysis to identify potential associations between hemostatic agent use and DVT/PE. METHODS: A single-institution review of patients undergoing surgical resection of cranial meningiomas was performed...
April 2014: Clinical Neurology and Neurosurgery
Christian Scheller, Jens Rachinger, Christian Strauss, Alex Alfieri, Julian Prell, Gershom Koman
OBJECTIVE: Deep venous thrombosis (DVT) and pulmonary embolism (PE) are major causes of postoperative morbidity and mortality in surgery. However, there is neither a standardized protocol for perioperative prevention of DVT or PE in neurosurgery nor a consensus concerning the management of postoperative DVT or PE after craniotomy in the early postoperative course. METHODS: We retrospectively analyzed management and complications in a group of patients with postoperative DVT or PE after craniotomy between 2006 and 2011 to estimate the risk of secondary hemorrhage under therapeutic anticoagulation...
January 2014: Journal of Neurological Surgery. Part A, Central European Neurosurgery
Shahla Siddiqui
Readmission to the surgical intensive care unit of a tertiary care hospital has traditionally been tracked as a quality indicator and many studies have suggested various figures as to the acceptable rate of such. ICU beds being a precious resource readmitting a patient could imply hasty discharge or inadequate care. Patients readmitted generally have a higher mortality and length of stay due to the worsening of their illness. The definition of 'ICU readmission' varies from either in the first 24 hours, to over the next 2 days or even whether the patient comes back during the entire period of admission...
2013: International Archives of Medicine
Akil P Patel, Michael T Koltz, Charles A Sansur, Mangla Gulati, D Kojo Hamilton
OBJECT: Patients requiring neurosurgical intervention are known to be at increased risk for deep vein thrombosis (DVT) and attendant morbidity and mortality. Pulmonary embolism (PE) is the most catastrophic sequela of DVT and is the direct cause of death in 16% of all in-hospital mortalities. Protocols for DVT screening and early detection, as well as treatment paradigms to prevent PE in the acute postoperative period, are needed in neurosurgery. The authors analyzed the effectiveness of weekly lower-extremity venous duplex ultrasonography (LEVDU) in patients requiring surgical intervention for cranial or spinal pathology for detection of DVT and prevention of PE...
March 2013: Journal of Neurosurgery
Marcos Mello Moreira, Renato Giuseppe Giovanni Terzi, Ilma Aparecida Paschoal, Luiz Cláudio Martins, Evandro Pinto da Luz Oliveira, Antonio Luis Eiras Falcão
This is the first report of a patient submitted to chemical thrombolysis due to massive pulmonary embolism (PE) during the postoperative period of neurosurgery, in whom due to the lack of adequate clinical conditions, no imaging assessment was performed. Clinical, gasometric and capnographic data allowed the decision to perform the thrombolysis with safety. The P(a-et)CO2 gradient decreased from 46.4 mmHg to 11.8 mmHg (normal < 5 mmHg) and the end-tidal alveolar dead space fraction decreased from 0.85 to 0...
October 2010: Arquivos Brasileiros de Cardiologia
N M Eliseeva, N K Serova, S S Gasparian, M A Shifrin
To study the specific features of development of papilledema (PE) in brain space-occupying lesions, the authors made a statistical analysis of neuroophthalmologic symptoms in 962 patients with brain tumors, colloid cysts of the third ventricle and cholesteatomas, who had been examined at the Research Institute of Neurosurgery during a calendar year. PE was identified in 30.8% of the patients. The frequency of PE was ascertained to depend on histological pattern, space-occupying lesion site, and age. Visual disturbances in PE were observed in more than a third of patients and manifested themselves as both diminished visual acuity and defects in the field of vision...
January 2008: Zhurnal Voprosy Neĭrokhirurgii Imeni N. N. Burdenko
Isabella S Keller, Christoph Meier, Roger Pfiffner, Emanuela Keller, Thomas Pfammatter
PURPOSE: To compare the clinical safety and efficiency of two optional inferior vena cava (IVC) filters. MATERIAL AND METHODS: Ninety-three consecutive Günther Tulip filters (92 patients) were compared with 83 consecutive OptEase filters (80 patients). Filters were placed at the same institution in patients with high-risk multiple trauma or those undergoing neurosurgery with contraindications to primary prophylaxis (70 patients in the Günther Tulip group and 44 in the OptEase group) and in patients with venous thromboembolism and contraindications to anticoagulation (22 patients in the Günther Tulip group and 36 in the OptEase group)...
April 2007: Journal of Vascular and Interventional Radiology: JVIR
Sarah F Smith, Michael T Biggs, Lali H S Sekhon
Acceptance is increasing for pharmacological prophylaxis against deep vein thrombosis (DVT) and pulmonary embolism (PE) for most types of surgery, but its use remains controversial in neurosurgical patients because of the threat of catastrophic hemorrhage. Consequently, mechanical measures such as sequential calf compression and graduated compression stockings are currently the preferred prophylaxis for neurosurgical patients. However, some patients remain at high risk despite these measures and may require prophylaxis with low molecular weight heparins or unfractionated heparin...
2005: Surgical Technology International
Nancy E Epstein
STUDY DESIGN: Intermittent pneumatic compression stockings (IPC) alone were prospectively used to avoid deep venous thrombosis (DVT) and pulmonary embolism (PE) in 100 consecutive patients undergoing single-level anterior corpectomy/fusion (ACF) and in 100 patients having multilevel ACF/posterior fusion. OBJECTIVES: To determine the optimal prophylaxis against DVT and PE for patients undergoing anterior cervical spinal surgery. BACKGROUND DATA: Mini-heparin and low-dose heparin prophylaxis in neurosurgery poses a 2% to 4% risk of major postoperative hemorrhage with resultant neurologic sequelae...
November 15, 2005: Spine
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