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. 2023 Aug 20;7(6):102172.
doi: 10.1016/j.rpth.2023.102172. eCollection 2023 Aug.

Acute venous thromboembolism in patients with brain cancer: clinical course

Cecilia Becattini  1 , Michela Giustozzi  1 , José Portillo  2 , Carmen Fernández-Capitán  3 , José Luis Lobo  4 , Ma Luisa Peris  5 , Carme Font  6 , Claire Grange  7 , Ido Weinberg  8 , Manuel Monreal  9 ; RIETE Investigators
Affiliations

Acute venous thromboembolism in patients with brain cancer: clinical course

Cecilia Becattini et al. Res Pract Thromb Haemost. .

Abstract

Background: Patients with brain cancer have been excluded or were underrepresented in studies on the treatment of venous thromboembolism (VTE), mainly due to the fear of intracranial hemorrhage (ICH).

Objectives: The aim of this study was to provide data on the risk of ICH, recurrent VTE, and major bleeding in patients with active brain cancer.

Methods: This was a multicenter, international cohort study at participating sites of the Registro Informatizado Enfermedad Tromboembólica Registry. Patients included in this study were classified as having known active brain cancer, active nonbrain cancer, or without active cancer. ICH at 3 months was the primary study outcome.

Results: Overall, 98,377 patients with VTE were included: 616 with active brain cancer, 16,807 with active nonbrain cancer, and 80,954 without active cancer. At 3 months follow-up, ICH occurred in 2.8%, 0.3%, and 0.2% of the patients, respectively, and was fatal in 1.3%, 0.2%, and 0.1%, respectively. Both rates of major bleeding (3.7% vs 3.2% vs 1.5%, respectively) and recurrent VTE (3.9% vs 3.4% vs 1.1%, respectively) were higher in patients with brain or nonbrain cancer than in patients without cancer. Glioblastomas were associated with a numerically higher risk of ICH, fatal ICH, and recurrent VTE than other brain tumors.

Conclusion: In patients with VTE, active brain cancer was associated with a higher risk of ICH or fatal ICH than nonbrain or no active cancer. Further studies are needed to assess the value of different treatment approaches in patients with brain cancer and VTE.

Keywords: anticoagulants; brain cancer; intracerebral hemorrhages; pulmonary embolism; venous thromboembolism.

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Figures

Figure 1
Figure 1
Cumulative rates of intracranial bleeding within the first 3 months in patients with brain cancer, cancer in other sites, or no cancer.
Figure 2
Figure 2
Cumulative rates of fatal pulmonary embolism and fatal bleeding within the first 3 months in patients with brain cancer and in those with other cancers. PE, pulmonary embolism.
Figure 3
Figure 3
Cumulative rates of intracranial bleeding within the first 3 months in patients with glioblastoma vs other brain cancers.
See this image and copyright information in PMC

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