Joeky Senders

62 Chapter 3 stockings or intermittent pneumatic compression devices) postoperatively until the end of hospitalization or until the patient is mobile. Absolute contra-indications for these include recent ICH or another active major bleeding. 16-19,54,55,57,58 Future research Despite its limitations, this study provides useful insight into the prevalence, timing, and risk factors of postoperative VTE and ICH after craniotomy for a primary malignant brain tumor. The results of the current study demonstrate that there is still room for improvement, especially with regards to the prevention of PE after hospitalization. Because of the distinct critical time periods for both thrombotic and hemorrhagic events, it could be worth to investigate the safety and efficacy of continuing prophylactic anticoagulation beyond discharge in high-risk patients. Additionally, the typical patient at risk for developing a VTE during hospitalization is not the same as the typical patient at risk for developing a VTE post-discharge. This is crucial for tailoring post- discharge management to the risk profile of the individual patient. Therefore, future research should study the effects of timing of thromboprophylactic therapy, screening for asymptomatic events, and patient education on the occurrence of VTE and/or ICH. Additionally, future studies should construct prediction models for VTE and ICH and examine the effectiveness of tailoring postoperative thromboprophylaxis to the individual risk profile of patients undergoing craniotomy for a primary malignant brain tumor. Conclusion The increased risk of VTE experienced by patients with a primary malignant brain tumor extends beyond the period of hospitalization, especially for PE, whereas ICH occurs predominantly in the first few days after surgery. The risk profile for VTE depends on the type of VTE and clinical setting. VTE can have fatal consequences if not recognized early, therefore clinicians should have high suspicion during the postoperative period and a low threshold for specific monitoring and prevention.