Outcomes in Neurosurgical Patients Who Develop Venous Thromboembolism: A Review of the RIETE Registry

• Published in: Clinical and applied thrombosis/hemostasis 2014-11, Vol.20 (8), p.772-778
• Main Authors: Cote, Lauren P., Greenberg, Steven, Caprini, Joseph A., Stone, James, Arcelus, Juan I., López-Jiménez, Luciano, Rosa, Vladimir, Schellong, Sebastian, Monreal, Manuel
• Format: Article
• Language: English
• Subjects: Adult; Aged; Anticoagulants - therapeutic use; Female; Humans; Male; Middle Aged; Neurosurgical Procedures - adverse effects; Postoperative Complications - drug therapy; Postoperative Complications - etiology; Postoperative Complications - mortality; Pulmonary Embolism - mortality; Registries; Venous Thromboembolism - drug therapy; Venous Thromboembolism - etiology; Venous Thromboembolism - mortality
• ISSN: 1076-0296; 1938-2723
• DOI: 10.1177/1076029614532008

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.