Tinzaparin vs. Nadroparin Safety and Efficacy in Neurosurgery

Wilhelmy, Florian; Hantsche, Annika; Gaier, Michael; Kasper, Johannes; Fehrenbach, Michael Karl; Oesemann, Rene; Meixensberger, Jürgen; Lindner, Dirk

doi:10.3390/neurolint13020021

Cited by 2 publications

(3 citation statements)

References 14 publications

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“…The need for informed consent was waived by the ethics committee of the University of Leipzig. Apart from the patient selection, methodology has been described before 8 , 11 , 12 . I confirm that all methods were performed in accordance with the relevant guidelines and regulations.…”

Section: Methodsmentioning

confidence: 99%

“…Risk factors for both bleeding and thromboembolic events have been largely examined. To prevent thromboembolism, prophylactic anticoagulation with low molecular weight heparin and its derivatives is standard in perioperative care 6 – 8 . There are various studies on whether or not to apply chemoprophylaxis or mechanical devices such as intermittent pneumatic compression boots in patients with intracranial pathologies 9 , 10 .…”

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confidence: 99%

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Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Wilhelmy,

Gaier,

Planitzer

et al. 2023

Sci Rep

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In the perioperative management of patients with glioblastoma (GBM), physicians face the question of whether and when to administer prophylactic or therapeutic anticoagulation (AC). In this study, we investigate the effects of the timing of postoperative heparinization on thromboembolic events (TE) and postoperative hemorrhage (bleeding, PH) as well as the interactions between the two in the context of an underlying intracerebral malignancy. For this retrospective data analysis, 222 patients who underwent surgery for grade IV glioblastoma, IDH-wildtype (2016 CNS WHO) between 01/01/2014 and 31/12/2019 were included. We followed up for 12 months. We assessed various biographical and clinical data for risk factors and focused on the connection between timepoint of AC and adverse events. Subgroup analyses were performed for pulmonary artery embolism (PE), deep vein thrombosis, and postoperative intracranial hemorrhage (PH) that either required surgical intervention or was controlled radiologically only. Statistical analysis was performed using Mann–Whitney U-Test, Chi-square test, Fisher’s exact test and univariate binomial logistic regression. p values below 0.05 were considered statistically significant. There was no significant association between prophylactic AC within 24 h and more frequent major bleeding (p = 0.350). AC in patients who developed major bleeding was regularly postponed by the physician/surgeon upon detection of the re-bleeding; therefore, patients with PH were anticoagulated significantly later (p = 0.034). The timing of anticoagulant administration did not differ significantly between patients who experienced a thromboembolic event and those who did not (p = 0.634). There was considerable overlap between the groups. Three of the six patients (50%) with PE had to be lysed or therapeutically anticoagulated and thereafter developed major bleeding (p < 0.001). Patients who experienced TE were more likely to die during hospitalization than those with major bleeding (p = 0.022 vs. p = 1.00). Prophylactic AC within 24 h after surgery does not result in more frequent bleeding. Our data suggests that postoperative intracranial hemorrhage is not caused by prophylactic AC but rather is a surgical complication or the result of antithrombotic therapy. However, thromboembolic events worsen patient outcomes far more than postoperative bleeding. The fact that bleeding may occur as a complication of life-saving lysis therapy in the setting of a thromboembolic event should be included in this cost–benefit consideration.

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Wilhelmy,

Gaier,

Planitzer

et al. 2023

Sci Rep

Self Cite

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“…A recent pilot study indicates that nadroparin, in comparison with dabigatran or rivaroxaban, showed no difference in bleeding complications in patients with total knee arthroplasty surgery (van der Veen et al, 2021). A retrospective study compared the safety and efficacy of tinzaparin and nadroparin in neurosurgery and showed no significant difference in bleeding events and incidence of VTE (Wilhelmy et al, 2021). Thus, the superiority of tinzaparin and nadroparin in the elderly needs to be further studied.…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of Low Molecular Weight Heparin for Thromboprophylaxis in the Elderly: A Network Meta-Analysis of Randomized Clinical Trials

Yang

Liu

et al. 2021

Front. Pharmacol.

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Background: Given their changing pathophysiology, elderly patients carry a high risk of embolism and bleeding events; hence, use of appropriate anticoagulants is very important. Low molecular weight heparin (LMWH) is one of the most widely used anticoagulants although LMWHs differ in their anti-Xa, antithrombin, and anticoagulant activities. To date, no study has directly compared the safety and efficacy of different LMWHs in the elderly. We aimed to compare such differences by conducting a network meta-analysis.Methods: We searched the Pubmed, Embase, and Cochrane databases for randomized controlled trials (RCTs) of LMWHs that included patients ≥60 years old up to July 22, 2020. Safety outcomes included venous thromboembolism (VTE) or VTE-related death, deep thrombus embolism, and pulmonary embolism. Safety outcomes were clinically relevant bleeding, major bleeding, minor bleeding, and all-cause death. We calculated relative ratios (RR) and 95% confidence intervals (CI) for all outcomes. The cumulative ranking probabilities (SUCRA) were conducted to rank the comparative effects and safety of all LMWHs.Results: We included 27 RCTs (30,441 elderly), comprising five LMWHs. LMWH was more effective than placebo in preventing VTE or VTE-related death (RR 0.36, 95% CI 0.25–0.53) but less effective than a novel oral anticoagulant (RR 1.59, 95% CI 1.33–1.91) and safer than acenocoumarol regarding risk of clinically relevant bleeding (RR 0.67, 95% CI 0.49–0.90). However, indirect comparison of efficacy and safety of the five LMWHs showed no significant difference in our network analysis, and the subgroup analyses (such as in patients with deep venous thrombosis, cardiac disease, or age >65 years old) supported the results. The SUCRA showed that tinzaparin performed best in preventing VTE or VTE-related death (SUCRA 68.8%, cumulative probability 42.3%) and all-cause death (SUCRA 84.2%, cumulative probability 40.7%), whereas nadroparin was predominant in decreasing the risk of clinically relevant bleeding (SUCRA 84.8%, cumulative probability 77.0%).Conclusions: On present evidence, there are no significant differences in the efficacy and safety of different LMWHs for the elderly. According to the rank probability analysis, nadroparin seems to be safer for the elderly with a high risk of bleeding, whereas tinzaparin is more effective for those with low bleeding risk.

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Tinzaparin vs. Nadroparin Safety and Efficacy in Neurosurgery

Cited by 2 publications

References 14 publications

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Venous thromboembolism and intracranial hemorrhage in patients undergoing glioblastoma surgery

Safety and Efficacy of Low Molecular Weight Heparin for Thromboprophylaxis in the Elderly: A Network Meta-Analysis of Randomized Clinical Trials

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