Evidence Table 50IPCD + GCS vs LMWH + GCS

Bibliographic referenceStudy TypeEvidence levelNo. of patientsPatients characteristicsInterventionComparisonLength of follow upOutcome measuresEffect sizeComments
Dickinson1998 164RCT1+Total: 66
Int1: n= 21
Int 2: n=23
Control:
n=22
Type of surgery:
Neurosurgery for intracranial neoplasms

Intervention 1:
Mean age: 43 (28– 61) yrs

Intervention 2:
Mean age: 50 (29– 72) yrs

Control:
Mean age: 49 (20– 72)

M/F numbers not reported

Pre-existing Risk Factors:
Not reported

Ecluded patients:
history of DVT or PE, allergy to heparin or other anticoagulant agents, history of surgery or major trauma to the lower extremities, concurrent condition requiring anticoagulation therapy; cranial base neoplasms and pituitary adenomas
Int 1: LWMH (Enoxaparin)
Dose: administered subcutaneously at a dose of 30mg in the anaesthesia holding room. He dose was continued at a dose of 30mg every 12 hours

Int 2: Combination of Enoxaparin and SCD
Dose: as before

Timing:.started before induction of anaesthesia until discharge from Neurosurgery Service.

Additional non-comparative prophylaxis:
antiembolic stockings on lower extremities at time of admission to the hospital

Int 2: Combination of LMWH and thigh high sequential compression device.
Type:
Thigh high sequential compression device

Timing: started before induction of anesthesia and continued postoperatively until patient was walking without assistance

Additional non-comparative prophylaxis:
antiembolic stockings on lower extremities at time of admission to the hospital
1 monthDVT Confirmed by: duplex imaging (on four occasions in the first 1 month after surgery)Int 1: 1/21
Control: 3/22
p value = 0.53

Int 2: 4/23
Comp: 3/22
P=0.90
Comments:
Study terminated early when it was determined that the enoxaparin treated groups exhibited a greater incidence of postoperative neurological deficits secondary to intracranial haemorrhage.

Not reported:
Post thrombotic leg, length of stay.

Funding: NR
Symptomatic PEInt 1: 0/21
Int 2: 0/23
Comp: 022
Bleeding related complications (intracerebral hemorrhage or epidural haematoma)Int 1: 2/21
Int 2: 3/23
Comp: 0/22
MortalityInt 1: 0/21
Int 2: 1/23
Comp: 122

From: Appendix D, Evidence tables

Cover of Venous Thromboembolism
Venous Thromboembolism: Reducing the Risk of Venous Thromboembolism (Deep Vein Thrombosis and Pulmonary Embolism) in Patients Admitted to Hospital.
NICE Clinical Guidelines, No. 92.
National Clinical Guideline Centre – Acute and Chronic Conditions (UK).
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