Skip to main content
Top
Published in: Current Treatment Options in Oncology 9/2023

Open Access 06-07-2023 | Brain Tumor

Management of Thromboembolic Disease in Patients with Primary and Metastatic Brain Tumors

Authors: Ryan R. Woods, MD, Glenn J. Lesser, MD

Published in: Current Treatment Options in Oncology | Issue 9/2023

Login to get access

Opinion statement

Patients with primary brain tumors are at a substantially elevated risk of venous thromboembolism (VTE) compared to other disease states or other forms of malignancy. Deep venous thrombosis (DVT) and pulmonary embolism (PE), often complicate the care of patients with primary brain tumors, and treatment may pose specific unique risks and considerations for management. This paper critically reviews the relevant literature and the most common treatment options in addition to a discussion regarding the relative risk considerations for neurooncology patients facing thromboembolic disease.
Literature
2.
go back to reference Jeraq M, et al. Venous thromboembolism in brain tumor patients. Adv Exp Med Biol. 2017;906:215–28.CrossRefPubMed Jeraq M, et al. Venous thromboembolism in brain tumor patients. Adv Exp Med Biol. 2017;906:215–28.CrossRefPubMed
3.
go back to reference Mir SeyedNazari P, et al. Combination of isocitrate dehydrogenase 1 (IDH1) mutation and podoplanin expression in brain tumors identifies patients at high or low risk of venous thromboembolism. J Thrombo Haemost: JTH. 2018;16(6):1121–7.CrossRef Mir SeyedNazari P, et al. Combination of isocitrate dehydrogenase 1 (IDH1) mutation and podoplanin expression in brain tumors identifies patients at high or low risk of venous thromboembolism. J Thrombo Haemost: JTH. 2018;16(6):1121–7.CrossRef
4.
go back to reference Agnelli G, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799–808.CrossRefPubMed Agnelli G, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799–808.CrossRefPubMed
5.
go back to reference Landman GW, Gans ROB. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2011;364(12):1178.CrossRefPubMed Landman GW, Gans ROB. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2011;364(12):1178.CrossRefPubMed
6.
go back to reference Goldhaber SZ, et al. Dabigatran versus warfarin for acute venous thromboembolism in elderly or impaired renal function patients: pooled analysis of RE-COVER and RE-COVER II. Thromb Haemost. 2017;117(11):2045–52.CrossRefPubMed Goldhaber SZ, et al. Dabigatran versus warfarin for acute venous thromboembolism in elderly or impaired renal function patients: pooled analysis of RE-COVER and RE-COVER II. Thromb Haemost. 2017;117(11):2045–52.CrossRefPubMed
7.
go back to reference Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9-16.PubMed Anderson FA Jr, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1):I9-16.PubMed
8.
go back to reference Bĕlohlávek J, et al. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129–38.PubMedPubMedCentral Bĕlohlávek J, et al. Pulmonary embolism, part I: Epidemiology, risk factors and risk stratification, pathophysiology, clinical presentation, diagnosis and nonthrombotic pulmonary embolism. Exp Clin Cardiol. 2013;18(2):129–38.PubMedPubMedCentral
9.
go back to reference Palareti G, et al. Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost. 2010;104(5):1063–70.PubMed Palareti G, et al. Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost. 2010;104(5):1063–70.PubMed
10.
go back to reference Robert-Ebadi H, Righini M. Should we diagnose and treat distal deep vein thrombosis?. Hematol Am Soc Hematol Educ Program. 2017;2017(1):231–6.CrossRef Robert-Ebadi H, Righini M. Should we diagnose and treat distal deep vein thrombosis?. Hematol Am Soc Hematol Educ Program. 2017;2017(1):231–6.CrossRef
11.
go back to reference Pinede L, et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation. 2001;103(20):2453–60.CrossRefPubMed Pinede L, et al. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation. 2001;103(20):2453–60.CrossRefPubMed
12.
go back to reference Kearon C, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340(12):901–7.CrossRefPubMed Kearon C, et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med. 1999;340(12):901–7.CrossRefPubMed
13.
go back to reference Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–738.CrossRefPubMedPubMedCentral Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv. 2020;4(19):4693–738.CrossRefPubMedPubMedCentral
14.
go back to reference Gómez-Outes A, Lagunar-Ruíz J, Terleira-Fernández AI, Calvo-Rojas G, Suárez-Gea ML, Vargas-Castrillón E. Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol. 2016;68(23):2508–21.CrossRefPubMed Gómez-Outes A, Lagunar-Ruíz J, Terleira-Fernández AI, Calvo-Rojas G, Suárez-Gea ML, Vargas-Castrillón E. Causes of death in anticoagulated patients with atrial fibrillation. J Am Coll Cardiol. 2016;68(23):2508–21.CrossRefPubMed
15.
go back to reference Khoury MN, et al. Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neuro-Oncol Pract. 2016;3(2):87–96.CrossRef Khoury MN, et al. Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neuro-Oncol Pract. 2016;3(2):87–96.CrossRef
16.
go back to reference Li Yao, et al. Risk factors for the incidence of apoplexy in pituitary adenoma: a single-center study from southwestern China. Chin Neurosurg J. 2020;6:20.CrossRefPubMedPubMedCentral Li Yao, et al. Risk factors for the incidence of apoplexy in pituitary adenoma: a single-center study from southwestern China. Chin Neurosurg J. 2020;6:20.CrossRefPubMedPubMedCentral
17.
go back to reference Chinot OL, et al. AVAglio: Phase 3 trial of bevacizumab plus temozolomide and radiotherapy in newly diagnosed glioblastoma multiforme. Adv Ther. 2011;28(4):334–40.CrossRefPubMed Chinot OL, et al. AVAglio: Phase 3 trial of bevacizumab plus temozolomide and radiotherapy in newly diagnosed glioblastoma multiforme. Adv Ther. 2011;28(4):334–40.CrossRefPubMed
19.
go back to reference Lee AYY, 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(2):146–53.CrossRefPubMed Lee AYY, 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(2):146–53.CrossRefPubMed
20.
go back to reference Deitcher SR, et al. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost. 2006;12(4):389–96.CrossRefPubMed Deitcher SR, et al. Secondary prevention of venous thromboembolic events in patients with active cancer: enoxaparin alone versus initial enoxaparin followed by warfarin for a 180-day period. Clin Appl Thromb Hemost. 2006;12(4):389–96.CrossRefPubMed
21.
go back to reference Lee AYY, et al. CATCH: a randomised clinical trial comparing long-term tinzaparin versus warfarin for treatment of acute venous thromboembolism in cancer patients. BMC Cancer. 2013;13:284.CrossRefPubMedPubMedCentral Lee AYY, et al. CATCH: a randomised clinical trial comparing long-term tinzaparin versus warfarin for treatment of acute venous thromboembolism in cancer patients. BMC Cancer. 2013;13:284.CrossRefPubMedPubMedCentral
22.
go back to reference Mantia C, et al. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood. 2017;129(25):3379–85.CrossRefPubMed Mantia C, et al. Predicting the higher rate of intracranial hemorrhage in glioma patients receiving therapeutic enoxaparin. Blood. 2017;129(25):3379–85.CrossRefPubMed
23.
go back to reference Chai-Adisaksopha C, et al. Outcomes of low-molecular-weight heparin treatment for venous thromboembolism in patients with primary and metastatic brain tumours. Thromb Haemost. 2017;117(3):589–94.CrossRefPubMed Chai-Adisaksopha C, et al. Outcomes of low-molecular-weight heparin treatment for venous thromboembolism in patients with primary and metastatic brain tumours. Thromb Haemost. 2017;117(3):589–94.CrossRefPubMed
24.
go back to reference Yust-Katz S, et al. Venous thromboembolism (VTE) and glioblastoma. J Neuro-Oncol. 2015;124(1):87–94.CrossRef Yust-Katz S, et al. Venous thromboembolism (VTE) and glioblastoma. J Neuro-Oncol. 2015;124(1):87–94.CrossRef
25.
go back to reference EINSTEIN–PE Investigators, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287–97.CrossRef EINSTEIN–PE Investigators, et al. Oral rivaroxaban for the treatment of symptomatic pulmonary embolism. N Engl J Med. 2012;366(14):1287–97.CrossRef
26.
go back to reference Prins MH, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013;11(1):21.CrossRefPubMedPubMedCentral Prins MH, et al. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb J. 2013;11(1):21.CrossRefPubMedPubMedCentral
28.
go back to reference • Raskob GE, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615–24. (The Hokusai VTE Cancer Trial was an important prospective trial establishing the safety of DOAC’s in cancer patients exclusively.)CrossRefPubMed • Raskob GE, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2018;378(7):615–24. (The Hokusai VTE Cancer Trial was an important prospective trial establishing the safety of DOAC’s in cancer patients exclusively.)CrossRefPubMed
29.
go back to reference Goldhaber SZ, Schellong S, Kakkar A, Eriksson H, Feuring M, Kreuzer J, Fraessdorf M, Schulman S. Treatment of acute pulmonary embolism with dabigatran versus warfarin. A pooled analysis of data from RE-COVER and RE-COVER II. Thromb Haemost. 2016;116(4):714–21.PubMed Goldhaber SZ, Schellong S, Kakkar A, Eriksson H, Feuring M, Kreuzer J, Fraessdorf M, Schulman S. Treatment of acute pulmonary embolism with dabigatran versus warfarin. A pooled analysis of data from RE-COVER and RE-COVER II. Thromb Haemost. 2016;116(4):714–21.PubMed
30.
go back to reference Carney BJ, et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors. J Thromb Haemost: JTH. 2019;17(1):72–6.CrossRefPubMed Carney BJ, et al. Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors. J Thromb Haemost: JTH. 2019;17(1):72–6.CrossRefPubMed
31.
go back to reference Young AM, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017–23.CrossRefPubMed Young AM, et al. Comparison of an oral factor Xa inhibitor with low molecular weight heparin in patients with cancer with venous thromboembolism: results of a randomized trial (SELECT-D). J Clin Oncol. 2018;36(20):2017–23.CrossRefPubMed
32.
go back to reference McBane RD 2nd, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial. J Thromb Haemost: JTH. 2020;18(2):411–21.CrossRefPubMed McBane RD 2nd, et al. Apixaban and dalteparin in active malignancy-associated venous thromboembolism: the ADAM VTE trial. J Thromb Haemost: JTH. 2020;18(2):411–21.CrossRefPubMed
33.
go back to reference •• Agnelli G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599–607. (The CARAVAGGIO study represents a recent review of a DOAC in cancer patients.)CrossRefPubMed •• Agnelli G, et al. Apixaban for the treatment of venous thromboembolism associated with cancer. N Engl J Med. 2020;382(17):1599–607. (The CARAVAGGIO study represents a recent review of a DOAC in cancer patients.)CrossRefPubMed
34.
go back to reference Streiff MB, et al. NCCN guidelines insights: cancer-associated venous thromboembolic disease, Version 2.2018. J Natl Compr Cancer Netw: JNCCN. 2018;16(11):1289–303.CrossRefPubMed Streiff MB, et al. NCCN guidelines insights: cancer-associated venous thromboembolic disease, Version 2.2018. J Natl Compr Cancer Netw: JNCCN. 2018;16(11):1289–303.CrossRefPubMed
36.
go back to reference Weitz JI, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017;376(13):1211–22.CrossRefPubMed Weitz JI, et al. Rivaroxaban or aspirin for extended treatment of venous thromboembolism. N Engl J Med. 2017;376(13):1211–22.CrossRefPubMed
37.
go back to reference Agnelli G, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368(8):699–708.CrossRefPubMed Agnelli G, et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013;368(8):699–708.CrossRefPubMed
Metadata
Title
Management of Thromboembolic Disease in Patients with Primary and Metastatic Brain Tumors
Authors
Ryan R. Woods, MD
Glenn J. Lesser, MD
Publication date
06-07-2023

Other articles of this Issue 9/2023

Current Treatment Options in Oncology 9/2023 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine