Systematic Review of Safety and Cost-Effectiveness of Venous Thromboembolism Prophylaxis Strategies in Patients Undergoing Craniotomy for Brain Tumor.

摘要: BACKGROUND Studies have evaluated various strategies to prevent venous thromboembolism (VTE) in neuro-oncology patients, without consensus. OBJECTIVE To perform a systematic review with cost-effectiveness analysis (CEA) of prophylaxis tumor patients undergoing craniotomy determine the safest and most cost-effective regimen. METHODS A literature search was conducted for VTE brain patients. Articles reporting type surgery, choice prophylaxis, outcomes were included. Safety determined by measuring rates intracranial hemorrhage. Cost estimates collected based on institutional data existing literature. CEA performed at 30 d after craniotomy, comparing following strategies: mechanical (MP), low molecular weight heparin MP (MP+LMWH), unfractionated (MP+UFH) symptomatic VTE. All costs reported 2016 US dollars. RESULTS total 34 studies reviewed (8 LMWH, 12 MP, 7 UFH individually or combination; 4 used LMWH preoperatively). Overall probability 1.49% (95% confidence interval (CI) 0.42-3.72) MP+UFH, 2.72% [95% CI 1.23-5.15] MP+LMWH, 2.59% 1.31-4.58) which not statistically significant. Compared control alone, number needed treat MP+UFH is 91 769 MP+LMWH. The risk hemorrhage 0.26% 0.01-1.34) 0.74% 0.09-2.61) 1.23-5.15) also harm 208 MP+LMWH 41. Fifteen included final CEA. estimated cost treatment $127.47 $142.20 $169.40 average per quality-adjusted life-year different $284.14 $338.39 $722.87 CONCLUSION Although frequently considered optimal reduction, our model suggests that measure balance risks lower may be more effective higher