Safety of perioperative minidose heparin in patients undergoing brain tumor surgery: a prospective, randomized, double-blind study

Object. Thromboembolic phenomena (TEPs) continue to be a significant source of morbidity and mortality in patients undergoing neurosurgery. Although t he efficacy of low-dose heparin in preventing TEPs in neurosurgical patient s is well established, neurosurgeons are reluctant to use it perioperativel y because of concern for increased bleeding complications. To clarify this issue, the authors used a prospective, randomized, double-blind design to e valuate the safety of minidose heparin treatment in patients undergoing sur gery for supratentorial brain tumors. Methods. One hundred three patients, all 40 years of age or older, were tre ated with either 5000 U of heparin (55 patients) or placebo (48 patients) s tarting 2 hours before surgery and continuing until full mobilization or fo r 7 days. Both groups were well matched for sex, weight, duration of surger y, and tumor diagnosis. Subjective and objective parameters were used to estimate and calculate the perioperative bleeding tendency in all patients. Red blood cell mass loss was calculated by assessing the preoperative and postoperative hematocrit a nd the patient's weight. Intraoperative blood loss was determined by measur ing the quantity of blood in the suction containers and subtracting the amo unt of irrigation fluids. Postoperative bleeding was measured by determinin g the amount of fluid in the subgaleal drain, and blood cell replacement wa s monitored during and after the procedure. Intracranial bleeding was grade d according to findings on the postoperative computerized tomography scan o btained 48 to 72 hours after surgery. In addition, the senior surgeon in ea ch case was asked to assess each patient's bleeding tendency during the ope ration. The results showed that perioperative administration of heparin did not significantly alter bleeding tendency by any measured parameter. The s urgeon was blinded to which group individual patients had been allocated. Conclusions. Perioperative minidose heparin is safe for use in patients und ergoing craniotomy for supratentorial tumors. This relatively simple and in expensive measure is recommended as a routine regimen for the prevention of TEPs in patients undergoing neurosurgery.