Key result
Neurosurgical patients developing VTE were more likely to die from pulmonary embolism than from bleeding in the first week, despite anticoagulation.
Why the study?
Are neurosurgical patients who develop VTE more likely to die of bleeding or VTE?
Cohort (n=392)
Are neurosurgical patients who develop VTE more likely to die of bleeding or VTE?
Neurosurgical patients who develop VTE are more likely to die from pulmonary embolism than from bleeding in the first week, despite anticoagulation.
Answers are grounded in this paper and cite their sources.
May favor anticoagulation despite bleeding risk in neurosurgical VTE; hypothesis-generating and requires prospective trials before practice change.
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 (0.96%) had VTE in less than 60 days after neurosurgery. Most patients in the cohort (89%) received initial therapy with low-molecular-weight heparin, (33% received subtherapeutic doses). In the first week, 10 (2.6%) patients died (8 with pulmonary embolism [PE], no bleeding deaths; P = .005). After the first week, 20 (5.1%) patients died (2 with fatal bleeding, none from PE). Overall, this cohort was more likely to develop a fatal PE than a fatal bleed (8 vs 2 deaths, P = .058). CONCLUSIONS: Neurosurgical patients developing VTE were more likely to die from PE than from bleeding in the first week, despite anticoagulation.
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Cote et al. (2014) conducted a cohort in Venous thromboembolism after neurosurgery (n=392). Venous thromboembolism was evaluated on Fatal pulmonary embolism versus fatal bleeding (p=0.058). Neurosurgical patients developing VTE were more likely to die from pulmonary embolism than from bleeding in the first week, despite anticoagulation.
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