Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy
Introduction Venous thromboembolic events (VTEs) like deep vein thrombosis or pulmonary embolism are frequent complications in (neuro) critical ill patients. Anticoagulation for VTE after space-occupying brain infarction is a therapeutic dilemma. The aim of this retrospective study was to investigat...
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| Series: | Stroke and Vascular Neurology |
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| author | Dominik Michalski Dirk Lindner Alhuda Dabbagh Janine Mielke Katja S Mühlberg Karl Titus Hoffmann Charlotte Huber Johann Otto Pelz |
| author_facet | Dominik Michalski Dirk Lindner Alhuda Dabbagh Janine Mielke Katja S Mühlberg Karl Titus Hoffmann Charlotte Huber Johann Otto Pelz |
| author_sort | Dominik Michalski |
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| description | Introduction Venous thromboembolic events (VTEs) like deep vein thrombosis or pulmonary embolism are frequent complications in (neuro) critical ill patients. Anticoagulation for VTE after space-occupying brain infarction is a therapeutic dilemma. The aim of this retrospective study was to investigate the frequency of clinically apparent VTE in patients with acute ischaemic stroke (AIS) due to large vessel occlusion (LVO), its treatment, and the rate of complications.Methods Patients with first AIS due to LVO were assigned to one of the following groups: space-occupying brain infarction with (1) or without (2) decompressive craniectomy (DC), AIS comprising more than 2/3 (3) or less than 2/3 (4) of the middle cerebral artery territory. Clinically obtained parameters included risk factors for VTE, type of thromboprophylaxis, treatment of VTE and treatment-associated complications.Results 15 of 173 (8.7%) patients had a VTE, which was diagnosed 10.9 ± 7.2 days after admission. Patients with a space-occupying brain infarction and DC had significantly more VTE (n=11/63; 17.5%) than patients with a space-occupying brain infarction without DC (0/26; p =0.023) or patients without DC (4/110; 3.6%; p = 0.004). Younger age, DC and cumulative duration of central venous catheter were identified as risk factors for VTE. Only three patients had major bleeding events while being anticoagulated (one asymptomatic cerebral and two extracranial bleedings).Discussion Patients with space-occupying brain infarction and DC hold a high risk for VTE. Despite extensive infarct size and DC, therapeutic anticoagulation required for VTE appeared to be safe regarding intracranial bleeding complications. |
| format | Article |
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| institution | Kabale University |
| issn | 2059-8696 |
| language | English |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Stroke and Vascular Neurology |
| spelling | doaj-art-d82d8a9ee5bc4c1785ddb98eb2f4f9482025-02-11T19:20:10ZengBMJ Publishing GroupStroke and Vascular Neurology2059-869610.1136/svn-2024-003808Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomyDominik Michalski0Dirk Lindner1Alhuda Dabbagh2Janine Mielke3Katja S Mühlberg4Karl Titus Hoffmann5Charlotte Huber6Johann Otto Pelz717 Neurology, University of Leipzig, Leipzig, Germany3 Department for Neurosurgery, University Hospital Leipzig, Leipzig, Saxony, GermanyDepartment of Neurology, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Neurology, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Angiology, University of Leipzig Medical Center, Leipzig, GermanyInstitute for Neuroradiology, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Neurology, University of Leipzig Medical Center, Leipzig, GermanyDepartment of Neurology, University of Leipzig Medical Center, Leipzig, GermanyIntroduction Venous thromboembolic events (VTEs) like deep vein thrombosis or pulmonary embolism are frequent complications in (neuro) critical ill patients. Anticoagulation for VTE after space-occupying brain infarction is a therapeutic dilemma. The aim of this retrospective study was to investigate the frequency of clinically apparent VTE in patients with acute ischaemic stroke (AIS) due to large vessel occlusion (LVO), its treatment, and the rate of complications.Methods Patients with first AIS due to LVO were assigned to one of the following groups: space-occupying brain infarction with (1) or without (2) decompressive craniectomy (DC), AIS comprising more than 2/3 (3) or less than 2/3 (4) of the middle cerebral artery territory. Clinically obtained parameters included risk factors for VTE, type of thromboprophylaxis, treatment of VTE and treatment-associated complications.Results 15 of 173 (8.7%) patients had a VTE, which was diagnosed 10.9 ± 7.2 days after admission. Patients with a space-occupying brain infarction and DC had significantly more VTE (n=11/63; 17.5%) than patients with a space-occupying brain infarction without DC (0/26; p =0.023) or patients without DC (4/110; 3.6%; p = 0.004). Younger age, DC and cumulative duration of central venous catheter were identified as risk factors for VTE. Only three patients had major bleeding events while being anticoagulated (one asymptomatic cerebral and two extracranial bleedings).Discussion Patients with space-occupying brain infarction and DC hold a high risk for VTE. Despite extensive infarct size and DC, therapeutic anticoagulation required for VTE appeared to be safe regarding intracranial bleeding complications.https://svn.bmj.com/content/early/2025/02/10/svn-2024-003808.full |
| spellingShingle | Dominik Michalski Dirk Lindner Alhuda Dabbagh Janine Mielke Katja S Mühlberg Karl Titus Hoffmann Charlotte Huber Johann Otto Pelz Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy Stroke and Vascular Neurology |
| title | Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy |
| title_full | Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy |
| title_fullStr | Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy |
| title_full_unstemmed | Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy |
| title_short | Frequency and treatment of venous thromboembolic events in patients with space-occupying brain infarction and decompressive craniectomy |
| title_sort | frequency and treatment of venous thromboembolic events in patients with space occupying brain infarction and decompressive craniectomy |
| url | https://svn.bmj.com/content/early/2025/02/10/svn-2024-003808.full |
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