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Thromb Haemost 2017; 117(03): 589-594
DOI: 10.1160/TH16-09-0680
Stroke, Systemic or Venous Thromboembolism
Schattauer GmbH

Outcomes of low-molecular-weight heparin treatment for venous thromboembolism in patients with primary and metastatic brain tumours

Chatree Chai-Adisaksopha
1   Department of Medicine, McMaster University, Hamilton, Canada
2   Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
,
Lori-Ann Linkins
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Said Y. ALKindi
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Matthew Cheah
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Mark A. Crowther
1   Department of Medicine, McMaster University, Hamilton, Canada
,
Alfonso Iorio
1   Department of Medicine, McMaster University, Hamilton, Canada
2   Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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Publikationsverlauf

Received: 04. September 2016

Accepted after major revision: 28. Januar 2016

Publikationsdatum:
22. November 2017 (online)

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Summary

Venous thromboembolism (VTE) is one of the most common complications in patients with brain tumours. There is limited data available in the literature on VTE treatment in these patients. We conducted a matched retrospective cohort study of patients with primary or metastatic brain cancer who were diagnosed with cancer-associated VTE. Patients were selected after a retrospective chart review of consecutive patients who were diagnosed with cancer-associated VTE between January 2010 and January 2014 at the Juravinski Thrombosis Clinic, Hamilton, Canada. Controls were age- and gender-matched patients with cancer-associated VTE from the same cohort, but without known brain tumours. A total of 364 patients with cancer-associated VTE were included (182 with primary or metastatic brain tumours and 182 controls). The median follow-up duration was 6.7 (interquartile range 2.5–15.8) months. The incidence rate of recurrent VTE was 11.0 per 100 patient-years (95 % CI; 6.7–17.9) in patients with brain tumours and 13.5 per 100 patient-years (95 % CI; 9.3–19.7) in non-brain tumour group. The incidence of major bleeding was 8.6 per 100 (95 % CI; 4.8–14.7) patient-years in patients with brain tumours versus 5.0 per 100 patient-years (95 % CI; 2.8–9.2) in controls. Rate of intracranial bleeding was higher in brain tumour patients (4.4 % vs 0 %, p-value=0.004). In summary, rates of recurrent VTE and major bleeding were not significantly different in patients with cancer-associated VTE in the setting of primary or metastatic brain tumours compared those without known brain tumours. However, greater numbers of intracranial bleeds were observed in patients with brain tumours.

Keywords

Anticoagulants - haemorrhage - cancer - low-molecular-weight heparin - venous thrombosis
 

  • References

  • 1 Fisher JL, Palmisano S, Schwartzbaum JA. et al. Comorbid conditions associated with glioblastoma. J Neurooncol 2014; 116: 585-591.
    CrossrefPubMedSuche in Google Scholar
  • 2 Constantini S, Kornowski R, Pomeranz S. et al. Thromboembolic phenomena in neurosurgical patients operated upon for primary and metastatic brain tumours. Acta Neurochir 1991; 109: 93-97.
    CrossrefPubMedSuche in Google Scholar
  • 3 Auguste KI, Quinones-Hinojosa A, Gadkary C. et al. Incidence of venous thromboembolism in patients undergoing craniotomy and motor mapping for glioma without intraoperative mechanical prophylaxis to the contralateral leg. J Neurosurg 2003; 99: 680-684.
    CrossrefPubMedSuche in Google Scholar
  • 4 Simanek R, Vormittag R, Hassler M. et al. Venous thromboembolism and survival in patients with high-grade glioma. Neuro Oncol 2007; 09: 89-95.
    CrossrefPubMedSuche in Google Scholar
  • 5 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: 1592-1596.
    CrossrefPubMedSuche in Google Scholar
  • 6 Chaichana KL, Pendleton C, Jackson C. et al. Deep venous thrombosis and pulmonary embolisms in adult patients undergoing craniotomy for brain tumours. Neurol Res 2013; 35: 206-211.
    CrossrefPubMedSuche in Google Scholar
  • 7 Semrad TJ, O’Donnell R, Wun T. et al. Epidemiology of venous thromboembolism in 9489 patients with malignant glioma. J Neurosurg 2007; 106: 601-608.
    CrossrefPubMedSuche in Google Scholar
  • 8 Hoke M, Dieckmann K, Koppensteiner R. et al. Prognostic value of plasma d-dimer levels in patients with glioblastoma multiforme - Results from a pilot study. Wien Klin Wochenschr 2011; 123: 199-203.
    CrossrefPubMedSuche in Google Scholar
  • 9 Vukovich TC, Gabriel A, Schaefer B. et al. Hemostasis activation in patients undergoing brain tumour surgery. Neurosurg Focus 1997; 02: e5.
    PubMedSuche in Google Scholar
  • 10 Gerber DE, Grossman SA, Streiff MB. Management of venous thromboembolism in patients with primary and metastatic brain tumours. J Clin Oncol 2006; 24: 1310-1318.
    CrossrefPubMedSuche in Google Scholar
  • 11 Knovich MA, Lesser GJ. The management of thromboembolic disease in patients with central nervous system malignancies. Curr Treat Options Oncol 2004; 05: 511-517.
    CrossrefPubMedSuche in Google Scholar
  • 12 Pan E, Tsai JS, Mitchell SB. Retrospective study of venous thromboembolic and intracerebral hemorrhagic events in glioblastoma patients. Anticancer Res 2009; 29: 4309-4313.
    PubMedSuche in Google Scholar
  • 13 Schiff D, DeAngelis LM. Therapy of venous thromboembolism in patients with brain metastases. Cancer 1994; 73: 493-498.
    CrossrefPubMedSuche in Google Scholar
  • 14 Levin JM, Schiff D, Loeffler JS. et al. Complications of therapy for venous thromboembolic disease in patients with brain tumours. Neurology 1993; 43: 1111-1114.
    CrossrefPubMedSuche in Google Scholar
  • 15 Vitale FV, Rotondo S, Sessa E. et al. Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: a case series study. J Oncol Pharm Pract 2012; 18: 10-16.
    CrossrefPubMedSuche in Google Scholar
  • 16 Altschuler E, Moosa H, Selker RG. et al. The risk and efficacy of anticoagulant therapy in the treatment of thromboembolic complications in patients with primary malignant brain tumours. Neurosurgery 1990; 27: 74-77.
    CrossrefPubMedSuche in Google Scholar
  • 17 Choucair AK, Silver P, Levin VA. Risk of intracranial hemorrhage in glioma patients receiving anticoagulant therapy for venous thromboembolism. J Neurosurg 1987; 66: 357-358.
    CrossrefPubMedSuche in Google Scholar
  • 18 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: 310-315.
    CrossrefPubMedSuche in Google Scholar
  • 19 Schmidt F, Faul C, Dichgans J. et al. Low molecular weight heparin for deep vein thrombosis in glioma patients. J Neurol 2002; 249: 1409-1412.
    CrossrefPubMedSuche in Google Scholar
  • 20 Lee AY, Levine MN, Baker RI. et al. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349: 146-153.
    CrossrefPubMedSuche in Google Scholar
  • 21 Bates SM, Greer IA, Middeldorp S. et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl. 02) e691S-736S.
    CrossrefPubMedSuche in Google Scholar
  • 22 Anderson DR, Kahn SR, Rodger MA. et al. Computed tomographic pulmonary angiography vs ventilation-perfusion lung scanning in patients with suspected pulmonary embolism: a randomized controlled trial. J Am Med Assoc 2007; 298: 2743-2753.
    CrossrefPubMedSuche in Google Scholar
  • 23 Chee CE, Ashrani AA, Marks RS. et al. Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study. Blood 2014; 123: 3972-3978.
    CrossrefPubMedSuche in Google Scholar
  • 24 Falanga A, Marchetti M. Anticancer treatment and thrombosis. Thromb Res 2012; 129: 353-359.
    CrossrefPubMedSuche in Google Scholar
  • 25 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: 494-499.
    CrossrefPubMedSuche in Google Scholar
  • 26 Salmaggi A, Erbetta A, Silvani A. et al. Intracerebral haemorrhage in primary and metastatic brain tumours. Neurol Sci 2008; 29 (Suppl. 02) S264-265.
    CrossrefPubMedSuche in Google Scholar
  • 27 Choi BC, Noseworthy AL. Classification, direction, and prevention of bias in epidemiologic research. J Occup Med 1992; 34: 265-271.
    CrossrefPubMedSuche in Google Scholar