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
Review
. 2024 Dec 6;2024(1):246-252.
doi: 10.1182/hematology.2024000660.

Management of anticoagulation in patients with brain metastasis

Eva N Hamulyák  1 , Shlomit Yust-Katz  2 , Avi Leader  3
Affiliations
Review

Management of anticoagulation in patients with brain metastasis

Eva N Hamulyák et al. Hematology Am Soc Hematol Educ Program. .

Abstract

Venous thromboembolism (VTE) is a prevalent and serious complication among cancer patients, necessitating therapeutic anticoagulation for many individuals with brain metastases. Simultaneously, patients with brain metastases, particularly those with high-risk primary tumors, have an increased risk of intracranial hemorrhage (ICH). Managing anticoagulation in these patients presents a dual challenge: preventing thromboembolism while avoiding hemorrhagic events. Here, we present our approach to anticoagulation for acute VTE in patients with brain metastases, based on the available evidence. We review potential risk factors for anticoagulation-associated ICH in this population and discuss strategies for managing acute VTE in patients with and without ICH.

PubMed Disclaimer

Conflict of interest statement

Eva. N. Hamulyák: no competing financial interests to declare.

Shlomit Yust-Katz: no competing financial interests to declare.

Avi Leader: honoraria: Leo-Pharma.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Brain MRI in a patient with non–small cell lung cancer and brain metastases. An axial section of a T1 image with contrast shows right frontal metastases (Panel A) and brain stem metastases (Panel B). The white arrows denote these findings.
Figure 2.
Figure 2.
Brain MRI in a patient with melanoma and hemorrhagic brain metastases. In Panel A, an axial section of a T1 image without contrast shows a right frontal hemorrhage (5  cm  ×  3  cm) with mass effect. In Panel B, a T1 image with contrast demonstrates improvement in the right frontal hemorrhage (3.5  cm  ×  2  cm) and its mass effect. The white arrows denote these findings.
See this image and copyright information in PMC

References

    1. Mulder FI, Horváth-Puhó E, van Es N, et al. Venous thromboembolism in cancer patients: a population-based cohort study. Blood. 2021;137(14): 1959-1969. - PubMed
    1. Khorana AA, Mackman N, Falanga A, et al. Cancer-associated venous thromboembolism. Nat Rev Dis Primers. 2022;8(1):11. - PubMed
    1. Zwicker JI, Liebman HA, Neuberg D, et al. Tumor-derived tissue factor- bearing microparticles are associated with venous thromboembolic events in malignancy. Clin Cancer Res. 2009;15(22):6830-6840. - PMC - PubMed
    1. Geddings JE, Mackman N.. Tumor-derived tissue factor-positive microparticles and venous thrombosis in cancer patients. Blood. 2013;122(11): 1873-1880. - PMC - PubMed
    1. Riedl J, Preusser M, Nazari PM, et al. Podoplanin expression in primary brain tumors induces platelet aggregation and increases risk of venous thromboembolism. Blood. 2017;129(13):1831-1839. - PMC - PubMed

MeSH terms