Contrasts in Glioblastoma—Venous Thromboembolism versus Bleeding Risk

Abstract

Glioblastoma is among the tumor entities with an extreme thrombogenic potential and patients are at very high risk of developing a venous thromboembolism (VTE) over the course of the disease, with an incidence of up to 30% per year. Major efforts are currently being made to understand and gain novel insights into the underlying pathomechanisms of the development of VTE in patients with glioblastoma and to find appropriate biomarkers. Yet, patients with glioblastoma not only face a high thromboembolic risk but are also at risk of bleeding events. In the case of VTE, a therapeutic anticoagulation with low molecular weight heparin or, in the case of low bleeding risk, treatment with a direct oral anticoagulant, is recommended, according to recently published guidelines. With respect to an elevated bleeding risk in glioblastoma patients, therapeutic anticoagulation remains challenging in this patient group and prospective data for this vulnerable patient group are scarce, particularly with regard to direct oral anticoagulants.

Characteristics and Outcomes of Intracranial Hemorrhage in Cancer Patients Visiting the Emergency Department

“…Although some primary brain tumors such as glioblastomas are extremely thrombogenic and also pathophysiologically prone to bleeding, their increased risk of hemorrhage did not affect survival. In fact, overall survival was higher for patients receiving anticoagulation for VTE [13]. Furthermore, Burth et al showed that the use of anticoagulants did not alter the risk of intracranial hemorrhage among patients with brain tumors (both primary and metastatic) [14].…”

Oncogenes and cancer associated thrombosis: what can we learn from single cell genomics about risks and mechanisms?

“…High-grade glioma (HGG), particularly grade IV that includes glioblastoma (GBM), is the most aggressive form of primary brain tumors, with GBM being associated with one of the highest risks of VTE (20%-30%) systemically (41,47). Moreover, GBMs manifest a consistent (and diagnostic) presence (~90%) of intratumoral microthrombosis (48)(49)(50)(51)(52). This is contrasted by a VTE risk of 8.2% for grade II and 9.2% for grade III gliomas (41) with correspondingly lower frequency of microthrombosis (52).…”