Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jul;20(7):1665-1673.
doi: 10.1111/jth.15739. Epub 2022 May 9.

Incidence and determinants of thrombotic and bleeding complications in patients with glioblastoma

Fleur H J Kaptein  1 , Milou A M Stals  1 , Maaike Y Kapteijn  1 , Suzanne C Cannegieter  1   2 , Linda Dirven  3   4 , Sjoerd G van Duinen  5 , Ronald van Eijk  5 , Menno V Huisman  1 , Eva E Klaase  1 , Martin J B Taphoorn  3   4 , Henri H Versteeg  1 , Jeroen T Buijs  1 , Johan A F Koekkoek  3   4 , Frederikus A Klok  1
Affiliations

Incidence and determinants of thrombotic and bleeding complications in patients with glioblastoma

Fleur H J Kaptein et al. J Thromb Haemost. 2022 Jul.

Abstract

Background: Glioblastoma patients are considered to be at high risk of venous thromboembolism (VTE) and major bleeding (MB), although reliable incidence estimates are lacking. Moreover, the risk of arterial thromboembolism (ATE) in these patients is largely unknown. Our aim was to assess the cumulative incidence, predictors, and prognostic impact of VTE, ATE, and MB on subsequent complications and mortality.

Methods: Cohort study of 967 consecutive patients diagnosed with glioblastoma between 2004-2020 in two hospitals. Patients were followed from 6 months before date of histopathological glioblastoma diagnosis up to 2 years after, or until an outcome of interest (VTE, ATE, and MB) or death occurred, depending on the analysis. Cumulative incidences were estimated with death as competing risk. Cox regression was used to identify predictors and the prognostic impact.

Results: A total of 101 patients were diagnosed with VTE, 50 with ATE, and 126 with MB during a median follow-up of 15 months (interquartile range 9.0-22). The adjusted 1-year cumulative incidence of VTE was 7.5% (95% confidence interval [CI] 5.9-9.3), of ATE 4.1% (95% CI 3.0-5.6), and of MB 12% (95% CI 9.6-14). Older age, type of surgery, and performance status were predictors of VTE. Incident VTE during follow-up was associated with MB (adjusted HR 4.7, 95% CI 2.5-9.0). MB and VTE were associated with mortality (adjusted HR 1.7, 95% CI 1.3-2.1 and 1.3, 95% CI 1.0-1.7, respectively).

Conclusion: We found considerable incidences of VTE and MB in glioblastoma patients, with both complications associated with poorer prognosis. Our observations emphasize the need for prospective studies to determine optimal thromboprophylaxis and VTE treatment strategy in these patients.

Keywords: anticoagulants; glioblastoma; hemorrhage; infarction; venous thromboembolism.

PubMed Disclaimer

Conflict of interest statement

F.A.K. reports research grants from Bayer, Merck Sharpe & Dohme, the Netherlands Organisation for Health Research and Development, Actelion, the Dutch Heart Foundation, and the Dutch Thrombosis Association, all outside the submitted work. M.V.H. reports unrestricted grant support from The Netherlands Organisation for Health Research and Development (ZonMW), and unrestricted grant support and fees for presentations from Boehringer‐Ingelheim, Pfizer‐BMS, Bayer Health Care, Aspen, Daiichi‐Sankyo, all outside the submitted work. The other authors have no conflicts of interest to declare.

Figures

FIGURE 1
FIGURE 1
Cumulative incidences of venous thromboembolism (A), arterial thromboembolism (B) and major bleeding (C), adjusted for the competing risk of death
See this image and copyright information in PMC

References

    1. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol. 2016;131:803‐820. - PubMed
    1. Perry JR. Thromboembolic disease in patients with high‐grade glioma. Neuro Oncol. 2012;14(Suppl 4):iv73‐iv80. - PMC - PubMed
    1. Simanek R, Vormittag R, Hassler M, et al. Venous thromboembolism and survival in patients with high‐grade glioma. Neuro Oncol. 2007;9:89‐95. - PMC - PubMed
    1. Jenkins EO, Schiff D, Mackman N, Key NS. Venous thromboembolism in malignant gliomas. J Thromb Haemost. 2010;8:221‐227. - PMC - PubMed
    1. Taillibert S, Taillandier L, Le Rhun E. Venous thrombosis in patients with high‐grade glioma. Curr Opin Oncol. 2015;27:516‐521. - PubMed