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Journal of Neurology
Published in: Journal of Neurology 7/2021

01-07-2021 | Direct Oral Anticoagulant | Review

A review of anticoagulation in patients with central nervous system malignancy: between a rock and a hard place

Authors: Dawn Swan, David Julian Seiffge, Jecko Thachil

Published in: Journal of Neurology | Issue 7/2021

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Abstract

The incidence and prevalence of patients who develop primary and secondary metastatic central nervous system cancer (CNS) is increasing. This is a consequence of advancements in the sensitivity and availability of diagnostic imaging, and improved therapeutic options, leading to increased detection of CNS malignancies and improved survival. These patients are at very high risk of thrombosis as well as haemorrhage, and the optimum management of anticoagulation can be challenging for treating clinicians, particularly as robust prospective evidence is sparse. In this focused review, we discuss (1) risk factors for thrombosis and bleeding in these patients, (2) management of acute venous thromboembolism (VTE) including evidence for direct oral anticoagulants, and how to approach patients with contraindications to anticoagulation, (3) ambulatory VTE prophylaxis, (4) VTE prophylaxis in patients who have undergone craniotomy for cancer, and (5) management of anticoagulation-related intracranial haemorrhage. Based on review of the available literature and author opinion, we propose practical management algorithms to aid clinicians faced with treating CNS cancer patients with thrombosis or CNS haemorrhage.
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Metadata
Title
A review of anticoagulation in patients with central nervous system malignancy: between a rock and a hard place
Authors
Dawn Swan
David Julian Seiffge
Jecko Thachil
Publication date
01-07-2021
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 7/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-09775-7

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