Risk factors for venous thromboembolism in glioma patients

Abstract

Background: Ranking third in the cause of death structure, venous thromboembolism (VTE) is a frequent complication in patients with central nervous system tumors.Objective: To assess the incidence of venous thrombosis and its risk factors in glioma patients based on retrospective data.Methods: Our retrospective study included 186 glioma patients from the Neurosurgery Department of Almazov National Medical Research Centre.Results: The VTE incidence was 8% in patients with brain neoplasms. Comparative analysis of 2 groups to identify VTE predictors showed that the probability of thrombosis increases with factors leading to the patient immobilization: altered mental status (40% [n = 6] in the VTE group vs 18% [n = 30] in the non-VTE group, OR: 3.1 [95% СI: 0.8–10.6], P = .080), neurological deficit (67% [n = 50] vs 29% [n = 10], OR: 4.8 [95% СI: 1.4–18.7], P = .007), and bed rest for more than 3 days (33% vs 4%, OR: 13.1 [95% СI: 2.7–62.8], P < .001). Based on the validation results, Caprini and IMPROVEDD risk scores have high negative predictive values: 0.99 [95% СI: 0.93–1.00] vs 0.97 [95% СI: 0.93–0.99] (P = .317). Caprini risk score has a specificity of 48.2% and a sensitivity of 93.3% (AUC = 78.98); the threshold value for high-risk VTE detection is 5.5 points. IMPROVEDD risk score has a specificity of 82.5% and a sensitivity of 73.3% (AUC = 81.1); the threshold value for high-risk VTE detection is 4.5 points.Conclusion: Our study revealed VTE risk factors in glioma patients, such as neurological deficit, prolonged bed rest (more than 3 days), and a high-grade tumor. We demonstrated high negative predictive values of Caprini and IMPROVEDD risk scores and determined their threshold values to be validated in a further prospective study. Due to the high incidence of VTE and risks of hemorrhage in patients with central nervous system tumors, personalized venous thrombosis risk calculators should be developed, providing for features of thrombosis pathogenesis in this patient group. Received 12 December 2022. Revised 7 April 2023. Accepted 31 May 2023. Funding: The study was supported by Ministry of Science and Higher Education of Russian Federation (No. 075-15-2022-301). Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: K.A. Pishchulov, M.A. SimakovaData collection and analysis: K.A. Pishchulov, S.I. ParkhomenkoStatistical analysis: V.L. LukinovDrafting the article: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. MoiseevaCritical revision of the article: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. MoiseevaFinal approval of the version to be published: K.A. Pishchulov, M.A. Simakova, V.L. Lukinov, S.I. Parkhomenko, N.E. Voinov, S.S. Sklyar, O.M. Moiseeva