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. 2022 Mar 12;24(3):455-464.
doi: 10.1093/neuonc/noab198.

Management of venous thromboembolism in high-grade glioma: Does low molecular weight heparin increase intracranial bleeding risk?

Jasmin Jo  1 , Joseph Donahue  2 , Guneet Sarai  3 , Gina Petroni  4 , David Schiff  5
Affiliations

Management of venous thromboembolism in high-grade glioma: Does low molecular weight heparin increase intracranial bleeding risk?

Jasmin Jo et al. Neuro Oncol. .

Abstract

Background: Venous thromboembolism (VTE) occurs in up to 30% of patients with high-grade glioma (HGG). Concern for increased risk of intracranial hemorrhage (ICH) with therapeutic anticoagulation (AC) complicates VTE treatment. Some retrospective studies have reported an increased risk of ICH associated with therapeutic AC; however, effective alternatives to AC are lacking. The aim of our study is to assess the risk of ICH in HGG patients with VTE on low molecular weight heparin (LMWH).

Methods: We performed a retrospective matched cohort study of HGG patients from January 2005 to August 2016. Blinded review of neuroimaging for ICH was performed. For analysis of the primary endpoint, estimates of cumulative incidence (CI) of ICH were calculated using competing risk analysis with death as competing risk; significance testing was performed using the Gray's test. Median survival was estimated using the Kaplan-Meier method.

Results: Two hundred twenty patients were included, 88 (40%) with VTE treated with LMWH, 22 (10%) with VTE, not on AC, and 110 (50%) without VTE. A total of 43 measurable ICH was recorded: 19 (26%) in LMWH, 3 (14%) in VTE not on AC, and 21 (19%) in non-VTE cohort. No significant difference was observed in the 1-year CI of ICH in the LMWH cohort and non-AC with VTE group (17% vs 9%; Gray's test, P = .36). Among patients without VTE, the 1-year CI of ICH was 13%. Median survival was similar among all 3 cohorts.

Conclusions: Our data suggest that therapeutic LMWH is not associated with substantially increased risk of ICH in HGG patients.

Keywords: glioblastoma; high-grade glioma; intracranial hemorrhage; low molecular weight heparin; venous thromboembolism.

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Figures

Fig. 1
Fig. 1
(a) Cumulative incidence of ICH in patients who developed VTE treated with LMWH vs those not treated with anticoagulation. (b) Cumulative incidence of ICH in patients who did not develop VTE. Abbreviations: ICH, intracranial hemorrhage; LMWH, low molecular weight heparin; VTE, venous thromboembolism.
Fig. 2
Fig. 2
(a) Median survival of all patients from the time of first HGG surgery. (b) Median survival of patients with VTE from the time of VTE diagnosis. Abbreviations: HGG, high-grade glioma; VTE, venous thromboembolism.
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