Antiplatelet medications and risk of intracranial hemorrhage in patients with metastatic brain tumors

Abstract

Although intracranial hemorrhage (ICH) is frequent in the setting of brain metastases, there are limited data on the influence of antiplatelet agents on the development of brain-tumor associated ICH. To evaluate whether the administration of anti-platelet agents increases the risk of ICH, we performed a matched cohort analysis of patients with metastatic brain tumors with blinded radiology review. Study population included 392 patients with metastatic brain tumors (134 received antiplatelet agents and 258 controls). Non-small cell lung cancer was the most common malignancy in the cohort (74.0%), followed by small cell lung cancer (9.9%), melanoma (4.6%), and renal cell cancer (4.3%). Among those who received an antiplatelet agent, 86.6% received aspirin alone and 23.1% received therapeutic anticoagulation during the study period. The cumulative incidence of any ICH at one year was 19.3% (95% CI, 14.1-24.4%) in patients not receiving anti-platelet agents compared to 22.5% (95% CI, 15.2-29.8%, Gray test P=0.22) in those receiving anti-platelet agents. Cumulative incidence of major ICH was 5.4% (95% CI, 2.6-8.3%) among controls compared with 5.5% (95% CI, 1.5-9.5%, P=0.80) in those exposed to antiplatelet agents. The combination of anticoagulation with antiplatelet agents did not increase the risk of major ICH. The use of antiplatelet agents was not associated with an increase in the incidence, size, or severity of ICH in the setting of brain metastases.

An MRI radiomics approach to discriminate haemorrhage-prone intracranial tumours before stereotactic biopsy

“…A recent meta-analysis reported that anticoagulation resulted in an increased risk of intracerebral haemorrhage by more than 3-fold in patients with gliomas but had no effect on brain metastasis 15 . For primary brain tumours 16 and metastatic brain tumours 17 , antiplatelet also induced no increase in the incidence of intracerebral haemorrhage. Therefore, to exclude this confounding effect, we excluded patients from our cohort if antiplatelet or anticoagulant were medicated.…”

Cancer and Cardiovascular Disease: The Conjoined Twins

“…Nonetheless, some of these trials that were designed to evaluate these chemo-preventive effects of selective COX-2 inhibitors, such as celecoxib and rofecoxib, showed an increased risk of major adverse cardiovascular events and were halted [94,95]. On contrast to selective COX-2 inhibitors, RCTs, observational case-control and meta-analysis studies have demonstrated a chemo-preventive effect of aspirin against colorectal cancers [96][97][98][99][100][101]. Other studies have also demonstrated that aspirin reduced the risk of death from several noncolonic solid cancers including esophageal, pancreatic, brain, lung, stomach, and prostate cancer in patients with Lynch syndrome [101,102].…”