Perioperative Thromboseprophylaxe und Risikofaktoren für thromboembolische Ereignisse bei Meningeom-Operationen

Postoperative thromboembolic events (TE) are significant complications following meningioma surgery. This study evaluates the impact of different thromboprophylaxis regimens—certoparin, enoxaparin and enoxaparin combined with pneumatic stockings (PS)—on TE incidence and investigates patient-specific, procedure-specific, and histological risk factors.

We prospectively analyzed data from 874 meningioma patients. Risk factors such as age, gender, intraoperative blood loss, surgery duration, histological subtypes, and thromboprophylaxis regimens were evaluated. Patients were stratified into three groups: (1) certoparin, (2) enoxaparin and (3) enoxaparin combined with PS. Statistical tests, including chi-square and ANOVA, were used to identify significant predictors.

Among the 874 patients, 3.1% experienced TE (n=27). The TE rates across the groups were comparable: certoparin (3.5%), enoxaparin (3.5%) and enoxaparin with PS (2.6%, p > 0.05). Advanced age (>65 years) (p=0.045) and intraoperative blood loss >200 ml (p=0.016) were significant independent risk factors for TE, particularly pulmonary embolism.

Histological subtypes were analyzed in detail. The most common subtype, meningothelial meningiomas (44.3% of cases, n=387), accounted for 48.1% of all TE (n=13). Fibrous meningiomas (16.7% of cases, n=146) were linked to 18.5% of all TE (n=5). Rare subtypes such as psammomatous, secretory, and transitional meningiomas collectively represented 16.1% of cases (n=141) and accounted for 3.6% of all TE (n=1). No TE cases were observed in even rarer subtypes, including clear-cell and chordoid meningiomas.

Thromboprophylaxis with certoparin, enoxaparin or enoxaparin combined with PS demonstrated similar efficacy in reducing postoperative TE. Patient-specific factors like advanced age and higher intraoperative blood loss were significant predictors of TE. Meningothelial meningiomas, the most frequent subtype, were associated with nearly half of all TE cases. While histological subtypes such as fibrous meningiomas showed a moderate association with TE, rare subtypes had minimal or no TE incidence. These findings emphasize the need for individualized thromboprophylaxis and careful perioperative management, particularly for patients with common histological subtypes or other risk factors.