Joeky Senders

70 Chapter 4 Abstract Introduction High-grade gliomas (HGG) are associated with venous thromboembolism (VTE). This study investigates the influence of continuing prophylactic anticoagulation post- discharge on the rate of VTE and intracranial hemorrhage (ICH) in patients operated for a HGG. Methods All adult patients who underwent sub- or gross-total resection for a HGG at a single institution were included. Multivariable logistic regression analysis was used to investigate the association between the duration of thromboprophylaxis (dalteparin administered 21 versus 0-7 days postoperatively) and the occurrence of VTE and ICH within 21 or 90 days after surgery, corrected for known risk factors. Results We included 301 patients, of whom 166 patients received short, and 135 received prolonged thromboprophylaxis. In the multivariable analysis, prolonged thromboprophylaxis was not significantly associated with the occurrence of VTE within 21 days (3.0% versus 1.2%; p = 0.24) or 90 days after surgery (8.9% versus 4.8%; p = 0.09); however, prolonged prophylaxis was associated with the occurrence of ICH (5.9% versus 0.6%; p = 0.03). Additionally, immobility (p = 0.03) and high BMI score (p = 0.02) were associated with the occurrence of VTE. Conclusions Twenty-one days of prophylactic anticoagulation postoperatively was not associated with a decreased rate of VTE compared to thromboprophylaxis until discharge. ICH was more common with prolonged thromboprophylaxis. These results provide insufficient evidence to extend the duration of prophylaxis beyond hospitalization. Large-scale randomized prospective studies are still needed to clarify the safety, efficacy, and optimal timing of postoperative thromboprophylaxis in HGG patients.