Download PDF
Semin Thromb Hemost 2016; 42(08): 877-883
DOI: 10.1055/s-0036-1592334
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Venous Thromboembolism in Patients with High-Grade Glioma

David J. Cote
1   Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Hassan Y. Dawood
1   Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
,
Timothy R. Smith
1   Department of Neurosurgery, Cushing Neurosurgical Outcomes Center, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
› Author Affiliations
Further Information

Publication History

Publication Date:
30 August 2016 (online)

    Permissions and Reprints

Corrected by:

Clinical Outcomes of Venous Thromboembolism in Patients with and without Cancer: The SWIss Venous ThromboEmbolism Registry (SWIVTER)Semin Thromb Hemost 2016; 42(06): 642-649
DOI: 10.1055/s-0036-1584131

Abstract

Venous thromboembolism (VTE), incorporating both deep vein thrombosis and pulmonary embolism, is a common, morbid, and potentially fatal condition. Patients undergoing surgery are at increased risk of VTE due to many perioperative factors, and patients undergoing surgery for high-grade glioma (HGG) have been found to be at an even higher risk than general surgical patients. Chemical prophylaxis of VTE during the postneurosurgical period remains one of the major dilemmas in modern neurosurgical practice due to a potential increased risk of devastating intracranial hemorrhage in the setting of anticoagulation. In this review, we aim to summarize the prevalence of VTE in patients with HGG and discuss relevant risk factors for the development of VTE after surgery for this malignancy. We also review options for VTE prophylaxis in the postoperative period and discuss appropriate management of these complex patients.

Keywords

neurosurgery - VTE - craniotomy - high-grade glioma
 

  • References

  • 1 Dhami MS, Bona RD, Calogero JA, Hellman RM. Venous thromboembolism and high grade gliomas. Thromb Haemost 1993; 70 (3) 393-396
    PubMedGoogle Scholar
  • 2 Hamilton MG, Hull RD, Pineo GF. Venous thromboembolism in neurosurgery and neurology patients: a review. Neurosurgery 1994; 34 (2) 280-296 , discussion 296
    CrossrefPubMedGoogle Scholar
  • 3 Clagett GP, Anderson Jr FA, Geerts W , et al. Prevention of venous thromboembolism. Chest 1998; 114 (5) 531S-560S
    CrossrefPubMedGoogle Scholar
  • 4 Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA. Prognosis of cancers associated with venous thromboembolism. N Engl J Med 2000; 343 (25) 1846-1850
    CrossrefPubMedGoogle Scholar
  • 5 Marras LC, Geerts WH, Perry JR. The risk of venous thromboembolism is increased throughout the course of malignant glioma: an evidence-based review. Cancer 2000; 89 (3) 640-646
    CrossrefPubMedGoogle Scholar
  • 6 D'Angelo A, Kluft C, Verheijen JH, Rijken DC, Mozzi E, Mannucci PM. Fibrinolytic shut-down after surgery: impairment of the balance between tissue-type plasminogen activator and its specific inhibitor. Eur J Clin Invest 1985; 15 (6) 308-312
    CrossrefPubMedGoogle Scholar
  • 7 Brandes AA, Scelzi E, Salmistraro G , et al. Incidence of risk of thromboembolism during treatment high-grade gliomas: a prospective study. Eur J Cancer 1997; 33 (10) 1592-1596
    CrossrefPubMedGoogle Scholar
  • 8 Yust-Katz S, Mandel JJ, Wu J , et al. Venous thromboembolism (VTE) and glioblastoma. J Neurooncol 2015; 124 (1) 87-94
    CrossrefPubMedGoogle Scholar
  • 9 Levitan N, Dowlati A, Remick SC , et al. Rates of initial and recurrent thromboembolic disease among patients with malignancy versus those without malignancy. Risk analysis using Medicare claims data. Medicine (Baltimore) 1999; 78 (5) 285-291
    CrossrefPubMedGoogle Scholar
  • 10 Simanek R, Vormittag R, Hassler M , et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro-oncol 2007; 9 (2) 89-95
    PubMedGoogle Scholar
  • 11 Walker AJ, Card TR, West J, Crooks C, Grainge MJ. Incidence of venous thromboembolism in patients with cancer - a cohort study using linked United Kingdom databases. Eur J Cancer 2013; 49 (6) 1404-1413
    CrossrefPubMedGoogle Scholar
  • 12 Chiocca EA, Schwartzbaum JA. Gliomas and venous thromboembolism: how common?. J Neurosurg 2007; 106 (4) 599-600 , discussion 600
    CrossrefPubMedGoogle Scholar
  • 13 Semrad TJ, O'Donnell R, Wun T , et al. Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 2007; 106 (4) 601-608
    CrossrefPubMedGoogle Scholar
  • 14 Zwicker JI, Karp RL, Carrier M. A meta-analysis of intracranial hemorrhage in patients with brain tumors receiving therapeutic anticoagulation. J Thromb Haemost 2016; (e-pub ahead of print). doi:10.1111/jth.13387
    PubMedGoogle Scholar
  • 15 Chang SM, Parney IF, Huang W , et al; Glioma Outcomes Project Investigators. Patterns of care for adults with newly diagnosed malignant glioma. JAMA 2005; 293 (5) 557-564
    CrossrefPubMedGoogle Scholar
  • 16 Clagett GP, Anderson Jr FA, Heit J, Levine MN, Wheeler HB. Prevention of venous thromboembolism. Chest 1995; 108 (4) 312S-334S
    CrossrefPubMedGoogle Scholar
  • 17 Jenkins EO, Schiff D, Mackman N, Key NS. Venous thromboembolism in malignant gliomas. J Thromb Haemost 2010; 8 (2) 221-227
    PubMedGoogle Scholar
  • 18 Perry JR. Thromboembolic disease in patients with high-grade glioma. Neuro-oncol 2012; 14 (Suppl. 04) iv73-iv80
    PubMedGoogle Scholar
  • 19 Fowkes FJ, Price JF, Fowkes FG. Incidence of diagnosed deep vein thrombosis in the general population: systematic review. Eur J Vasc Endovasc Surg 2003; 25 (1) 1-5
    CrossrefPubMedGoogle Scholar
  • 20 Valladares JB, Hankinson J. Incidence of lower extremity deep vein thrombosis in neurosurgical patients. Neurosurgery 1980; 6 (2) 138-141
    CrossrefPubMedGoogle Scholar
  • 21 Smith SF, Biggs MT, Sekhon LH. Risk factors and prophylaxis for deep venous thrombosis in neurosurgery. Surg Technol Int 2005; 14: 69-76
    PubMedGoogle Scholar
  • 22 Cote DJ, Smith TR. Venous thromboembolism in brain tumor patients. J Clin Neurosci 2016; 25: 13-18
    CrossrefPubMedGoogle Scholar
  • 23 Smith TR, Lall RR, Graham RB , et al. Venous thromboembolism in high grade glioma among surgical patients: results from a single center over a 10 year period. J Neurooncol 2014; 120 (2) 347-352
    CrossrefPubMedGoogle Scholar
  • 24 Browd SR, Ragel BT, Davis GE, Scott AM, Skalabrin EJ, Couldwell WT. Prophylaxis for deep venous thrombosis in neurosurgery: a review of the literature. Neurosurg Focus 2004; 17 (4) E1
    PubMedGoogle Scholar
  • 25 Timp JF, Braekkan SK, Versteeg HH, Cannegieter SC. Epidemiology of cancer-associated venous thrombosis. Blood 2013; 122 (10) 1712-1723
    CrossrefPubMedGoogle Scholar
  • 26 Agnelli G. Prevention of venous thromboembolism in surgical patients. Circulation 2004; 110 (24) (Suppl. 01) IV4-IV12
    CrossrefPubMedGoogle Scholar
  • 27 Smith SF, Simpson JM, Sekhon LH. Prophylaxis for deep venous thrombosis in neurosurgical oncology: review of 2779 admissions over a 9-year period. Neurosurg Focus 2004; 17 (4) E4
    PubMedGoogle Scholar
  • 28 Chan AT, Atiemo A, Diran LK , et al. Venous thromboembolism occurs frequently in patients undergoing brain tumor surgery despite prophylaxis. J Thromb Thrombolysis 1999; 8 (2) 139-142
    CrossrefPubMedGoogle Scholar
  • 29 Chaichana KL, Pendleton C, Jackson C , et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumors. Neurol Res 2013; 35 (2) 206-211
    CrossrefPubMedGoogle Scholar
  • 30 Streiff MB, Segal J, Grossman SA, Kickler TS, Weir EG. ABO blood group is a potent risk factor for venous thromboembolism in patients with malignant gliomas. Cancer 2004; 100 (8) 1717-1723
    CrossrefPubMedGoogle Scholar
  • 31 Quevedo JF, Buckner JC, Schmidt JL, Dinapoli RP, O'Fallon JR. Thromboembolism in patients with high-grade glioma. Mayo Clin Proc 1994; 69 (4) 329-332
    CrossrefPubMedGoogle Scholar
  • 32 Attia J, Ray JG, Cook DJ, Douketis J, Ginsberg JS, Geerts WH. Deep vein thrombosis and its prevention in critically ill adults. Arch Intern Med 2001; 161 (10) 1268-1279
    CrossrefPubMedGoogle Scholar
  • 33 Geerts WH, Jay RM, Code KI , et al. A comparison of low-dose heparin with low-molecular-weight heparin as prophylaxis against venous thromboembolism after major trauma. N Engl J Med 1996; 335 (10) 701-707
    CrossrefPubMedGoogle Scholar
  • 34 Stein PD, Gottschalk A, Saltzman HA, Terrin ML. Diagnosis of acute pulmonary embolism in the elderly. J Am Coll Cardiol 1991; 18 (6) 1452-1457
    CrossrefPubMedGoogle Scholar
  • 35 Le Gal G, Bounameaux H. Diagnosing pulmonary embolism: running after the decreasing prevalence of cases among suspected patients. J Thromb Haemost 2004; 2 (8) 1244-1246
    CrossrefPubMedGoogle Scholar
  • 36 Bajaj N, Bozarth AL, Guillot J , et al. Clinical features in patients with pulmonary embolism at a community hospital: analysis of 4 years of data. J Thromb Thrombolysis 2014; 37 (3) 287-292
    CrossrefPubMedGoogle Scholar
  • 37 Swann KW, Black PM. Deep vein thrombosis and pulmonary emboli in neurosurgical patients: a review. J Neurosurg 1984; 61 (6) 1055-1062
    CrossrefPubMedGoogle Scholar
  • 38 Michiels JJ, Gadisseur A, van der Planken M , et al. Screening for deep vein thrombosis and pulmonary embolism in outpatients with suspected DVT or PE by the sequential use of clinical score: a sensitive quantitative D-dimer test and noninvasive diagnostic tools. Semin Vasc Med 2005; 5 (4) 351-364
    Article in Thieme ConnectPubMedGoogle Scholar
  • 39 Wells PS, Anderson DR, Bormanis J , et al. Value of assessment of pretest probability of deep-vein thrombosis in clinical management. Lancet 1997; 350 (9094) 1795-1798
    Google Scholar
  • 40 Tamariz LJ, Eng J, Segal JB , et al. Usefulness of clinical prediction rules for the diagnosis of venous thromboembolism: a systematic review. Am J Med 2004; 117 (9) 676-684
    CrossrefPubMedGoogle Scholar
  • 41 Sartori MT, Della Puppa A, Ballin A , et al. Circulating microparticles of glial origin and tissue factor bearing in high-grade glioma: a potential prothrombotic role. Thromb Haemost 2013; 110 (2) 378-385
    Article in Thieme ConnectPubMedGoogle Scholar
  • 42 Ruff RL, Posner JB. Incidence and treatment of peripheral venous thrombosis in patients with glioma. Ann Neurol 1983; 13 (3) 334-336
    CrossrefPubMedGoogle Scholar
  • 43 Kayser-Gatchalian MC, Kayser K. Thrombosis and intracranial tumors. J Neurol 1975; 209 (3) 217-224
    CrossrefPubMedGoogle Scholar
  • 44 Khorana AA, Connolly GC. Assessing risk of venous thromboembolism in the patient with cancer. J Clin Oncol 2009; 27 (29) 4839-4847
    CrossrefPubMedGoogle Scholar
  • 45 Sawaya R, Zuccarello M, Elkalliny M, Nishiyama H. Postoperative venous thromboembolism and brain tumors: Part I. Clinical profile. J Neurooncol 1992; 14 (2) 119-125
    PubMedGoogle Scholar
  • 46 Huerta C, Johansson S, Wallander MA, García Rodríguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom. Arch Intern Med 2007; 167 (9) 935-943
    CrossrefPubMedGoogle Scholar
  • 47 Johannesdottir SA, Horváth-Puhó E, Dekkers OM , et al. Use of glucocorticoids and risk of venous thromboembolism: a nationwide population-based case-control study. JAMA Intern Med 2013; 173 (9) 743-752
    CrossrefPubMedGoogle Scholar
  • 48 Khorana AA, Kuderer NM, Culakova E, Lyman GH, Francis CW. Development and validation of a predictive model for chemotherapy-associated thrombosis. Blood 2008; 111 (10) 4902-4907
    CrossrefPubMedGoogle Scholar
  • 49 Agnelli G, Piovella F, Buoncristiani P , et al. Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 1998; 339 (2) 80-85
    CrossrefPubMedGoogle Scholar
  • 50 Vanek VW. Meta-analysis of effectiveness of intermittent pneumatic compression devices with a comparison of thigh-high to knee-high sleeves. Am Surg 1998; 64 (11) 1050-1058
    PubMedGoogle Scholar
  • 51 Kurtoglu M, Yanar H, Bilsel Y , et al. Venous thromboembolism prophylaxis after head and spinal trauma: intermittent pneumatic compression devices versus low molecular weight heparin. World J Surg 2004; 28 (8) 807-811
    CrossrefPubMedGoogle Scholar
  • 52 Velmahos GC, Nigro J, Tatevossian R , et al. Inability of an aggressive policy of thromboprophylaxis to prevent deep venous thrombosis (DVT) in critically injured patients: are current methods of DVT prophylaxis insufficient?. J Am Coll Surg 1998; 187 (5) 529-533
    CrossrefPubMedGoogle Scholar
  • 53 Marti C, John G, Konstantinides S , et al. Systemic thrombolytic therapy for acute pulmonary embolism: a systematic review and meta-analysis. Eur Heart J 2015; 36 (10) 605-614
    CrossrefPubMedGoogle Scholar
  • 54 Robins HI, O'Neill A, Gilbert M , et al. Effect of dalteparin and radiation on survival and thromboembolic events in glioblastoma multiforme: a phase II ECOG trial. Cancer Chemother Pharmacol 2008; 62 (2) 227-233
    CrossrefPubMedGoogle Scholar
  • 55 Perry SL, Bohlin C, Reardon DA , et al. Tinzaparin prophylaxis against venous thromboembolic complications in brain tumor patients. J Neurooncol 2009; 95 (1) 129-134
    CrossrefPubMedGoogle Scholar
  • 56 Iorio A, Agnelli G. Low-molecular-weight and unfractionated heparin for prevention of venous thromboembolism in neurosurgery: a meta-analysis. Arch Intern Med 2000; 160 (15) 2327-2332
    CrossrefPubMedGoogle Scholar
  • 57 Gould MK, Garcia DA, Wren SM , et al. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e227S-277S
    CrossrefPubMedGoogle Scholar
  • 58 Norwood SH, McAuley CE, Berne JD , et al. A potentially expanded role for enoxaparin in preventing venous thromboembolism in high risk blunt trauma patients. J Am Coll Surg 2001; 192 (2) 161-167
    CrossrefPubMedGoogle Scholar
  • 59 Simonneau G, Sors H, Charbonnier B , et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l'Embolie Pulmonaire. N Engl J Med 1997; 337 (10) 663-669
    CrossrefPubMedGoogle Scholar
  • 60 Kim J, Gearhart MM, Zurick A, Zuccarello M, James L, Luchette FA. Preliminary report on the safety of heparin for deep venous thrombosis prophylaxis after severe head injury. J Trauma 2002; 53 (1) 38-42 , discussion 43
    CrossrefPubMedGoogle Scholar
  • 61 Investigators TC ; The Columbus Investigators. Low-molecular-weight heparin in the treatment of patients with venous thromboembolism. N Engl J Med 1997; 337 (10) 657-662
    CrossrefPubMedGoogle Scholar
  • 62 Perry JR, Julian JA, Laperriere NJ , et al. PRODIGE: a randomized placebo-controlled trial of dalteparin low-molecular-weight heparin thromboprophylaxis in patients with newly diagnosed malignant glioma. J Thromb Haemost 2010; 8 (9) 1959-1965
    CrossrefPubMedGoogle Scholar
  • 63 Choucair AK, Silver P, Levin VA. Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism. J Neurosurg 1987; 66 (3) 357-358
    CrossrefPubMedGoogle Scholar
  • 64 Pan E, Tsai JS, Mitchell SB. Retrospective study of venous thromboembolic and intracerebral hemorrhagic events in glioblastoma patients. Anticancer Res 2009; 29 (10) 4309-4313
    PubMedGoogle Scholar
  • 65 Norden AD, Bartolomeo J, Tanaka S , et al. Safety of concurrent bevacizumab therapy and anticoagulation in glioma patients. J Neurooncol 2012; 106 (1) 121-125
    CrossrefPubMedGoogle Scholar
  • 66 Khoury MN, Missios S, Edwin N , et al. Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neurooncol Pract 2016; 3 (2) 87-96
    PubMedGoogle Scholar
  • 67 Schiff D, DeAngelis LM. Therapy of venous thromboembolism in patients with brain metastases. Cancer 1994; 73 (2) 493-498
    CrossrefPubMedGoogle Scholar
  • 68 Alvarado G, Noor R, Bassett R , et al. Risk of intracranial hemorrhage with anticoagulation therapy in melanoma patients with brain metastases. Melanoma Res 2012; 22 (4) 310-315
    CrossrefPubMedGoogle Scholar
  • 69 Donato J, Campigotto F, Uhlmann EJ , et al. Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study. Blood 2015; 126 (4) 494-499
    CrossrefPubMedGoogle Scholar
  • 70 Olin JW, Young JR, Graor RA, Ruschhaupt WF, Beven EG, Bay JW. Treatment of deep vein thrombosis and pulmonary emboli in patients with primary and metastatic brain tumors. Anticoagulants or inferior vena cava filter?. Arch Intern Med 1987; 147 (12) 2177-2179
    CrossrefPubMedGoogle Scholar
  • 71 Akl EA, van Doormaal FF, Barba M , et al. Parenteral anticoagulation for prolonging survival in patients with cancer who have no other indication for anticoagulation. Cochrane Database Syst Rev 2007; (3) CD006652
    PubMedGoogle Scholar
  • 72 Kuderer NM, Ortel TL, Francis CW. Impact of venous thromboembolism and anticoagulation on cancer and cancer survival. J Clin Oncol 2009; 27 (29) 4902-4911
    CrossrefPubMedGoogle Scholar
  • 73 Lee AY, Levine MN, Baker RI , et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (2) 146-153
    CrossrefPubMedGoogle Scholar
  • 74 Ghanim AJ, Daskalakis C, Eschelman DJ, Kraft WK. A five-year, retrospective, comparison review of survival in neurosurgical patients diagnosed with venous thromboembolism and treated with either inferior vena cava filters or anticoagulants. J Thromb Thrombolysis 2007; 24 (3) 247-254
    CrossrefPubMedGoogle Scholar
  • 75 Geerts WH, Pineo GF, Heit JA , et al. Prevention of venous thromboembolism: the seventh ACCP conference on antithrombotic and thrombolytic therapy. Chest 2004; 126 (3, Suppl) 338S-400S
    CrossrefPubMedGoogle Scholar
  • 76 Levin JM, Schiff D, Loeffler JS, Fine HA, Black PM, Wen PY. Complications of therapy for venous thromboembolic disease in patients with brain tumors. Neurology 1993; 43 (6) 1111-1114
    CrossrefPubMedGoogle Scholar
  • 77 Carman TL, Kanner AA, Barnett GH, Deitcher SR. Prevention of thromboembolism after neurosurgery for brain and spinal tumors. South Med J 2003; 96 (1) 17-22
    CrossrefPubMedGoogle Scholar
  • 78 Gerlach R, Raabe A, Beck J, Woszczyk A, Seifert V. Postoperative nadroparin administration for prophylaxis of thromboembolic events is not associated with an increased risk of hemorrhage after spinal surgery. Eur Spine J 2004; 13 (1) 9-13
    CrossrefPubMedGoogle Scholar
  • 79 Raj D, Marshall RW. Prophylaxis against thromboembolism in spinal surgery. Arch Orthop Trauma Surg 2008; 128 (12) 1365-1371
    CrossrefPubMedGoogle Scholar
  • 80 Cupitt JM. Prophylaxis against thromboembolism in patients with traumatic brain injury: a survey of UK practice. Anaesthesia 2001; 56 (8) 780-785
    PubMedGoogle Scholar
  • 81 Deep K, Jigajinni MV, Fraser MH, McLean AN. Prophylaxis of thromboembolism in spinal injuries—survey of practice in spinal units in the British Isles. Injury 2002; 33 (4) 353-355
    CrossrefPubMedGoogle Scholar
  • 82 Dickinson LD, Miller LD, Patel CP, Gupta SK. Enoxaparin increases the incidence of postoperative intracranial hemorrhage when initiated preoperatively for deep venous thrombosis prophylaxis in patients with brain tumors. Neurosurgery 1998; 43 (5) 1074-1081
    CrossrefPubMedGoogle Scholar
  • 83 Scales DC, Riva-Cambrin J, Le TL, Pinto R, Cook DJ, Granton JT ; Canadian Critical Care Trials Group. Prophylaxis against venous thromboembolism in neurointensive care patients: survey of Canadian practice. J Crit Care 2009; 24 (2) 176-184
    CrossrefPubMedGoogle Scholar
  • 84 Zareba P, Wu C, Agzarian J, Rodriguez D, Kearon C. Meta-analysis of randomized trials comparing combined compression and anticoagulation with either modality alone for prevention of venous thromboembolism after surgery. Br J Surg 2014; 101 (9) 1053-1062
    CrossrefPubMedGoogle Scholar
  • 85 Farge D, Debourdeau P, Beckers M , et al. International clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. J Thromb Haemost 2013; 11 (1) 56-70
    CrossrefPubMedGoogle Scholar
  • 86 Lyman GH, Bohlke K, Khorana AA , et al; American Society of Clinical Oncology. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology Clinical Practice Guideline Update 2014. J Clin Oncol 2015; 33 (6) 654-656
    CrossrefPubMedGoogle Scholar
  • 87 Smith TR, Nanney III AD, Lall RR , et al. Development of venous thromboembolism (VTE) in patients undergoing surgery for brain tumors: results from a single center over a 10 year period. J Clin Neurosci 2015; 22 (3) 519-525
    CrossrefPubMedGoogle Scholar