Introduction: Hemostatic agents are widely used in patients undergoing intracranial tumor resection. These agents promote local hemostasis through activation of the clotting cascade, and may potentially activate systemic clotting resulting in 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 craniotomy for meningioma from 2009-2012 was performed. Information on patient demographics, procedure duration, estimated blood loss (EBL), tumor pathology, use of hemostatic matrix (FloSeal), and the presence of DVT/PE within 30 days of surgery was collected.
Results: A total of 466 patients underwent a craniotomy for meningioma from 2009-2012. There were 330 females and 136 males with a mean age of 58.0 ± 13.5 years (range 18-92) and a mean BMI of 28.6 ± 13.3. Tumor pathology included 353 grade I, 76 grade II, and 31 grade III tumors. There were 13 patients (2.8%) with thromboembolic events. Age (p=0.25), gender (p=0.46), BMI (p=0.26), and EBL (p=0.79) were not associated an increased incidence of DVT/PE. The use of FloSeal was associated with DVT/PE, as 12/13 (92%) patients with thromboembolic events received greater than 10 ml (one package) of FloSeal compared to 258/453 (60%) patients without DVT/PE (p=0.01). Procedure duration was also predictive, with a mean procedure time of 483 ± 267 minutes in patients with DVT/PE vs. 343 ± 178 minutes in patients without thrombotic events (p=0.003). Tumor grade trended towards significance (p=0.19), with increased incidence of DVT/PE in patients with high-grade meningiomas.
Conclusions: Use of hemostatic matrix may be associated with an increased risk of DVT/PE in patients undergoing meningioma resection. This finding provides the impetus for more definitive clinical and laboratory studies to further characterize this phenomenon and its underlying biologic mechanism.
Patient Care: Improved understanding of risk factors associated with thromboembolic events
Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the risk factors of peri-operative thromboembolic events, 2) Discuss the potential role of hemostatic agents in DVT/PE, 3) Identify future areas of investigation