Abstract
PurposeThere is no compelling outcome data or clear guidance surrounding postoperative venous thromboembolism (VTE) prophylaxis using low molecular weight heparin (chemoprophylaxis) in patients undergoing pituitary surgery. Here we describe our experience of early chemoprophylaxis (post-operative day 1) following trans-sphenoidal pituitary surgery.MethodsSingle-centre review of a prospective surgical database and VTE records. Adults undergoing first time trans-sphenoidal pituitary surgery were included (2009–2018). VTE was defined as either deep vein thrombosis and/or pulmonary embolism within 3 months of surgery. Postoperative haematomas were those associated with a clinical deterioration together with radiological evidence.Results651 Patients included with a median age of 55 years (range 16–86 years). Most (99%) patients underwent trans-sphenoidal surgery using a standard endoscopic single nostril or bi-nostril trans-sphenoidal technique. More than three quarters had pituitary adenomas (n = 520, 80%). Postoperative chemoprophylaxis to prevent VTE was administered in 478 patients (73%). Chemoprophylaxis was initiated at a median of 1 day post-procedure (range 1–5 days postoperatively; 92% on postoperative day 1). Tinzaparin was used in 465/478 patients (97%) and enoxaparin was used in 14/478 (3%). There were no cases of VTE, even in 78 ACTH-dependent Cushing’s disease patients. Six patients (1%) developed postoperative haematomas. Chemoprophylaxis was not associated with a significantly higher rate of postoperative haematoma formation (Fisher’s Exact, p = 0.99) or epistaxis (Fisher’s Exact, p > 0.99).ConclusionsChemoprophylaxis after trans-sphenoidal pituitary surgery on post-operative day 1 is a safe strategy to reduce the risk of VTE without significantly increasing the risk of postoperative bleeding events.
Highlights
Venous thromboembolism (VTE) is the composite of deep vein thrombosis and pulmonary embolism, which are serious and potentially fatal complications of neurosurgery
The aim of this study was to describe our experience of chemoprophylaxis following trans-sphenoidal pituitary surgery and identify the rate of relevant outcomes, such as VTE and clinically significant bleeding events including epistaxis and post-operative haematoma formation
The electronic patient record was reviewed and data extracted on demographics, histological diagnosis, operative intervention, postoperative course and the development of VTE or clinically significant bleeding events including epistaxis and postoperative haematomas
Summary
Venous thromboembolism (VTE) is the composite of deep vein thrombosis and pulmonary embolism, which are serious and potentially fatal complications of neurosurgery. The risk of VTE can be reduced through mechanical thromboprophylaxis with compression stockings and intermittent pneumatic compression, along with pharmacological thromboprophylaxis (chemoprophylaxis). These measures can be used in conjunction. There is limited evidence of benefit for mechanical thromboprophylaxis in patients receiving pharmacological agents and for those patients who are critically ill [1, 2]. There is strong evidence of benefit for
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