Management of venous thromboembolism in patients with glioma

Megren, Mosaad Al; Wit, Carine de; Qahtani, Mohammad Al; Gal, Grégoire Le; Carrier, Marc

doi:10.1016/j.thromres.2017.06.010

Cited by 31 publications

(23 citation statements)

References 10 publications

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“…Al Megren et al described a 7-fold increase in risk of ICH in patients with glioma who received full dose anticoagulation for treatment of acute VTE compared with matched glioma patients without VTE. 56 The best evidence for risk of ICH during anticoagulation in brain tumors is currently provided by a meta-analysis of nine retrospective cohort studies from Zwicker et al 57 Overall, a 3-fold higher risk of ICH in glioma patients receiving therapeutic anticoagulation was reported, as compared with matched controls without anticoagulant treatment. The risk of fatal ICH, however, was low, with an incidence of less than 1%.…”

Section: Clinical Challenges and Management Of Vte In Brain Cancer Trmentioning

confidence: 99%

Venous Thromboembolism in Brain Tumors: Risk Factors, Molecular Mechanisms, and Clinical Challenges

Riedl

2019

Semin Thromb Hemost

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Venous thromboembolism (VTE) is a common complication in patients with primary brain tumors, with up to 20% of patients per year having a VTE event. Clinical risk factors for VTE include glioblastoma subtype, paresis, or surgery. Furthermore, specific factors playing a role in tumor biology were recently identified to predispose to prothrombotic risk. For instance, mutations in the isocitrate dehydrogenase 1 (IDH1) gene, which occurs in a subgroup of glioma, correlate with risk of VTE, with low incidence in patients with presence of an IDH1 mutation compared with those with IDH1 wild-type status. In addition, expression of the glycoprotein podoplanin on brain tumors was associated with both intratumoral thrombi and high risk of VTE. As podoplanin has the ability to activate platelets, a mechanistic role of podoplanin-mediated platelet activation in VTE development has been suggested. From a clinical point of view, the management of patients with primary brain tumors and VTE is challenging. Anticoagulation is required to treat patients; however, it is associated with increased risk of intracranial hemorrhage. This review focuses on describing the epidemiology, risk factors, and mechanisms of brain tumor-associated thrombosis and discusses clinical challenges in the prevention and treatment of VTE in patients with brain tumors.

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Section: Clinical Challenges and Management Of Vte In Brain Cancer Trmentioning

confidence: 99%

Venous Thromboembolism in Brain Tumors: Risk Factors, Molecular Mechanisms, and Clinical Challenges

Riedl

2019

Semin Thromb Hemost

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“…[2] VTE may be a prognostic factor for these patients. [3] Thrombin an enzyme in blood plasma, causes the clotting of blood by converting fibrinogen to fibrin.…”

Section: Introductionmentioning

confidence: 99%

Increased expression of von Willebrand factor gene is associated with poorer survival in primary lower grade glioma

Lehrer

Rheinstein²,

Rosenzweig

2018

Glioma

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Background: Venous thromboembolism is a common complication in patients with glioma. The clotting factor von Willebrand factor (VWF) is a highly adhesive procoagulant molecule that mediates platelet adhesion to endothelial and subendothelial surfaces. In the current analysis, we examined The Cancer Genome Atlas (TCGA) data to assess the effect of VWF gene expression on prognosis in patients with lower grade gliomas (LGGs). Methods: For newly diagnosed gliomas, we evaluated the association between and overall survival in the genomic data commons TCGA LGG dataset in TCGA. Survival data of the glioma subgroup were extracted for analysis and generation of Kaplan–Meier curves for overall survival. Results: Lower grade gliomas with less VWF gene expression had significantly better survival than those with more VWF gene expression (hazard ratio 0.64, 95% confidence interval 0.44–0.92, P 0.015 log rank test). The effect of VWF gene expression on survival was even more evident when the sample was analyzed as three groups (P = 0.00019). IDH1, TP53, and ATRX mutations are present in 40% or more adult LGGs. Conclusion: The deleterious prognostic effect of VWF expression in LGGs is not surprising, given its role in other cancers. Therefore, VWF gene expression may be a clinically important risk marker in LGG.

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“…In previous studies, the rates of ICH following craniotomy for brain tumors is cited as 1.0–4.0% with a follow-up ranging between the initial hospital stay and long-term survival after surgery [ 6 , 13 – 15 , 44 , 46 – 48 ]. However, definitions for major ICH varied between volumetric measurement of the hematoma, presence of symptoms, decrease in hemoglobin, or need for surgical evacuation of hematoma [ 14 , 15 , 21 , 23 , 24 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

“…Neither did this study stratify for the clinical setting of the patient. Risk factors associated with ICH were history of craniotomy, use of bevacizumab, and therapeutic anticoagulation for VTE [ 13 , 20 – 24 ]. The association between thromboprophylactic anticoagulation and ICH remains to be elucidated [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of ICH is lower compared to VTE events, their outcomes can be at least as detrimental. Only few predictors associated with ICH have been identified including history of craniotomy, use of bevacizumab, and therapeutic anticoagulation for a VTE [ 13 , 20 – 24 ]. Adequate assessment of the perioperative risk of both VTE and ICH among this patient population, as well as accurately predicting the typical time to a thrombotic or hemorrhagic event, is meaningful in tailoring postoperative management to the risk profile of the individual patient.…”

Section: Introductionmentioning

confidence: 99%

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Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

et al. 2017

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Venous thromboembolism (VTE), including deep venous thrombosis (DVT) and pulmonary embolism (PE), frequently complicates the postoperative course of primary malignant brain tumor patients. Thromboprophylactic anticoagulation is commonly used to prevent VTE at the risk of intracranial hemorrhage (ICH). We extracted all patients who underwent craniotomy for a primary malignant brain tumor from the National Surgical Quality Improvement Program (NSQIP) registry (2005–2015) to perform a time-to-event analysis and identify relevant predictors of DVT, PE, and ICH within 30 days after surgery. Among the 7376 identified patients, the complication rates were 2.6, 1.5, and 1.3% for DVT, PE, and ICH, respectively. VTE was the second-most common major complication and third-most common reason for readmission. ICH was the most common reason for reoperation. The increased risk of VTE extends beyond the period of hospitalization, especially for PE, whereas ICH occurred predominantly within the first days after surgery. Older age and higher BMI were overall predictors of VTE. Dependent functional status and longer operative times were predictive for VTE during hospitalization, but not for post-discharge events. Admission two or more days before surgery was predictive for DVT, but not for PE. Preoperative steroid usage and male gender were predictive for post-discharge DVT and PE, respectively. ICH was associated with various comorbidities and longer operative times. This multicenter study demonstrates distinct critical time periods for the development of thrombotic and hemorrhagic events after craniotomy. Furthermore, the VTE risk profile depends on the type of VTE (DVT vs. PE) and clinical setting (hospitalized vs. post-discharge patients).

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Management of venous thromboembolism in patients with glioma

Cited by 31 publications

References 10 publications

Venous Thromboembolism in Brain Tumors: Risk Factors, Molecular Mechanisms, and Clinical Challenges

Venous Thromboembolism in Brain Tumors: Risk Factors, Molecular Mechanisms, and Clinical Challenges

Increased expression of von Willebrand factor gene is associated with poorer survival in primary lower grade glioma

Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a National Surgical Quality Improvement Program analysis

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