Prevention of deep vein thrombosis in neurosurgical patients with brain tumors: A controlled, randomized study comparing graded compression stockings alone and with intermittent sequential compression. Correlation with pre- and postoperative fibrinolysis.

Postoperative venous thromboembolism is a common problem in neurosurgery. Moreover, patients with brain tumors have an increasing risk of developing deep vein thrombosis (DVT), depending on the histology of the tumor. The aim of this study is to compare graded compression stockings (GCS) alone and GCS combined with intermittent gradient sequential pneumatic compression (GCS/IPC) for the prevention of postoperative DVT in patients undergoing brain tumor surgery. The primary endpoint is a bilateral ascending phlebogram obtained on the 8th postoperative day. Preliminary results are available on 23 patients who completed the study. The incidence of postoperative DVT was 40% (2/5) in the GCS group and 0% (0/18) in the GCS/IPC group. Both patients with DVT had meningioma. There was no clear association between pre- and postoperative fibrinolytic activity estimated by euglobulin clot lysis time and D-dimer level. These preliminary results suggest that GCS combined with IPC is more effective than GCS alone in preventing postoperative DVT in patients undergoing brain tumor surgery. However, the sample size is not sufficient to draw a definite conclusion.