Direct oral anticoagulants vs. low-molecular-weight heparin for pulmonary embolism in patients with glioblastoma.
Direct oral anticoagulation
Glioblastoma survival
Low-molecular-weight heparin
Pulmonary embolism
Therapeutic anticoagulation
Journal
Neurosurgical review
ISSN: 1437-2320
Titre abrégé: Neurosurg Rev
Pays: Germany
ID NLM: 7908181
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
20
01
2021
accepted:
01
04
2021
revised:
03
03
2021
pubmed:
27
4
2021
medline:
12
2
2022
entrez:
26
4
2021
Statut:
ppublish
Résumé
Glioblastoma (GBM) is a cancer type with high thrombogenic potential and GBM patients are therefore at a particularly high risk for thrombotic events. To date, only limited data on anticoagulation management after pulmonary embolism (PE) in GBM is available and the sporadic use of DOACs remains off-label. A retrospective cohort analysis of patients with GBM and postoperative, thoracic CT scan confirmed PE was performed. Clinical course, follow-up at 6 and 12 months and the overall survival (OS) were evaluated using medical charts and neuroradiological data. Out of 584 GBM patients, 8% suffered from postoperative PE. Out of these, 30% received direct oral anticoagulants (DOACs) and 70% low-molecular-weight heparin (LMWH) for therapeutic anticoagulation. There was no significant difference in major intracranial hemorrhage (ICH), re-thrombosis, or re-embolism between the two cohorts. Although statistically non-significant, a tendency to reduced mRS at 6 and 12 months was observed in the LMWH cohort. Furthermore, patients receiving DOACs had a statistical benefit in OS. In our analysis, DOACs showed a satisfactory safety profile in terms of major ICH, re-thrombosis, and re-embolism compared to LMWH in GBM patients with postoperative PE. Prospective, randomized trials are urgent to evaluate DOACs for therapeutic anticoagulation in GBM patients with PE.
Identifiants
pubmed: 33900495
doi: 10.1007/s10143-021-01539-9
pii: 10.1007/s10143-021-01539-9
pmc: PMC8827361
doi:
Substances chimiques
Anticoagulants
0
Heparin, Low-Molecular-Weight
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
451-457Informations de copyright
© 2021. The Author(s).
Références
Dubinski D, Keil F, Won SY, Behmanesh B, Jahnke K, Seifert V, Geisen C, Konczalla J, Senft C (2020) Pulmonary embolism in neurocritical care-introduction of a novel grading system for risk stratification: the Frankfurt AMBOS score. Neurosurg Rev. https://doi.org/10.1007/s10143-020-01310-6
doi: 10.1007/s10143-020-01310-6
pubmed: 32399727
pmcid: 8035103
Farge D, Frere C, Connors JM, Ay C, Khorana AA, Munoz A, Brenner B, Kakkar A, Rafii H, Solymoss S, Brilhante D, Monreal M, Bounameaux H, Pabinger I, Douketis J, Ageno W, Ajauro F, Al-Aboudi KR, Alcindor T, Andre T, Angchaisuksiri P, Antic D, Arcelus JI, Assenat E, Bauer KA, Bazarbachii A, Benzidia I, Beyer-Westendorf J, Bitsadze V, Blickstein D, Blostein M, Bogalho I, Bournet B, Casais P, Carpentier AF, Cesarman-Maus G, Chakbrabartty J, Clemente H, Connault J, Doucet L, Durant C, Emmerich J, Falanga A, Feistritzer C, Font C, Francis C, Gallardo E, Gary T, Gris JC, Guillermo C, Hij A, Hull RD, IKezoe T, Jara-Palomares L, Key NS, Khrizroeva J, Koolian M, Langer F, Le Hello C, Lecumberri R, Lee LH, Liebman H, Lopes Dos Santos L, Machado DH, Madelaine I, Makatsariya A, Mandala M, Marayevas A, Marjanovic Z, Marosi C, Martin E, Meillon L, Messas E, Moreira A, Demir AM, Ndour A, Nguessan M, Otero-Candelera R, Pachon Olmos V, Pais A, Posch F, Preusser M, Riess H, Righini M, Rothschild C, Roussin A, Rueda-Camino JA, Ruiz-Artacho P, Saseedharan S, Shamseddine A, Soff G, Stricker H, Tagalakis V, Taher A, Toussaint T, Trujillo-Santos J, Villiers S, Wong R, Yamada N (2019) 2019 international clinical practice guidelines for the treatment and prophylaxis of venous thromboembolism in patients with cancer. Lancet Oncol 20:e566–e581
doi: 10.1016/S1470-2045(19)30336-5
Gerber DE, Grossman SA, Streiff MB (2006) Management of venous thromboembolism in patients with primary and metastatic brain tumors. J Clin Oncol 24:1310–1318
doi: 10.1200/JCO.2005.04.6656
Hirsh J, Ginsberg JS (2018) Edoxaban for the treatment of venous thromboembolism in patients with cancer. N Engl J Med 378:673–674. https://doi.org/10.1056/nejme1800041
doi: 10.1056/nejme1800041
pubmed: 29443673
Jenkins EO, Schiff D, Mackman N, Key NS (2010) Venous thromboembolism in malignant gliomas. J Thromb Haemost 8:221–227. https://doi.org/10.1111/j.1538-7836.2009.03690.x
doi: 10.1111/j.1538-7836.2009.03690.x
pubmed: 19912518
Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI, Wong SL, Balaban EP, Flowers CR, Francis CW, Gates LE, Kakkar AK, Levine MN, Liebman HA, Tempero MA, Lyman GH, Falanga A (2020) Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 38:496–520
doi: 10.1200/JCO.19.01461
Khoury MN, Missios S, Edwin N, Sakruti S, Barnett G, Stevens G, Peereboom DM, Khorana AA, Ahluwalia MS (2016) Intracranial hemorrhage in setting of glioblastoma with venous thromboembolism. Neuro-Oncology Pract 3:87–96. https://doi.org/10.1093/nop/npv028
doi: 10.1093/nop/npv028
Lin RJ, Green DL, Shah GL (2018) Therapeutic anticoagulation in patients with primary brain tumors or secondary brain metastasis. Oncologist 23:468–473. https://doi.org/10.1634/theoncologist.2017-0274
doi: 10.1634/theoncologist.2017-0274
pubmed: 29158366
Noch E, Khalili K (2009) Molecular mechanisms of necrosis in glioblastoma: the role of glutamate excitotoxicity. Cancer Biol Ther 8:1791–1797
doi: 10.4161/cbt.8.19.9762
Raskob GE, van Es N, Verhamme P, Carrier M, Di Nisio M, Garcia D, Grosso MA, Kakkar AK, Kovacs MJ, Mercuri MF, Meyer G, Segers A, Shi M, Wang T-F, Yeo E, Zhang G, Zwicker JI, Weitz JI, Büller HR (2018) Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med 378:615–624. https://doi.org/10.1056/nejmoa1711948
doi: 10.1056/nejmoa1711948
Roth P, Pace A, Le Rhun E, Weller M, Ay C, Cohen-Jonathan Moyal E, Coomans M, Giusti R, Jordan K, Nishikawa R, Winkler F, Hong YK, Ruda R, Villà S, Taphoorn MJB, Wick W, Preusser M (2020) Neurological and vascular complications of primary and secondary brain tumours: EANO-ESMO clinical practice guidelines for prophylaxis, diagnosis, treatment and follow-up†. Ann Oncol 10:171–182. https://doi.org/10.1016/j.annonc.2020.11.003
doi: 10.1016/j.annonc.2020.11.003
Schulman S, Kearon C (2005) Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 3:692–694
doi: 10.1111/j.1538-7836.2005.01204.x
Senders JT, Goldhaber NH, Cote DJ, Muskens IS, Dawood HY, De Vos FYFL, Gormley WB, Smith TR, Broekman MLD (2018) Venous thromboembolism and intracranial hemorrhage after craniotomy for primary malignant brain tumors: a national surgical quality improvement program analysis. J Neurooncol 136:135–145. https://doi.org/10.1007/s11060-017-2631-5
doi: 10.1007/s11060-017-2631-5
pubmed: 29039075
Tawil N, Bassawon R, Rak J (2019) Oncogenes and clotting factors: the emerging role of tumor cell genome and epigenome in cancer-associated thrombosis. Semin Thromb Hemost 45:373–384. https://doi.org/10.1055/s-0039-1687891
doi: 10.1055/s-0039-1687891
pubmed: 31096313
Walker AJ, Card TR, West J, Crooks C, Grainge MJ (2013) Incidence of venous thromboembolism in patients with cancer-a cohort study using linked United Kingdom databases. Eur J Cancer 49:1404–1413. https://doi.org/10.1016/j.ejca.2012.10.021
doi: 10.1016/j.ejca.2012.10.021
pubmed: 23146958
Wen PY, Weller M, Lee EQ, Alexander BM, Barnholtz-Sloan JS, Barthel FP, Batchelor TT, Bindra RS, Chang SM, Chiocca EA, Cloughesy TF, DeGroot JF, Galanis E, Gilbert MR, Hegi ME, Horbinski C, Huang RY, Lassman AB, Le Rhun E, Lim M, Mehta MP, Mellinghoff IK, Minniti G, Nathanson D, Platten M, Preusser M, Roth P, Sanson M, Schiff D, Short SC, Taphoorn MJB, Tonn JC, Tsang J, Verhaak RGW, von Deimling A, Wick W, Zadeh G, Reardon DA, Aldape KD, van den Bent MJ (2020) Glioblastoma in adults: a Society for Neuro-Oncology (SNO) and European Society of Neuro-Oncology (EANO) consensus review on current management and future directions. Neuro Oncol 22:1073–1113. https://doi.org/10.1093/neuonc/noaa106
doi: 10.1093/neuonc/noaa106
pubmed: 32328653
pmcid: 7594557
Young AM, Marshall A, Thirlwall J, Chapman O, Lokare A, Hill C, Hale D, Dunn JA, Lyman GH, Hutchinson C, MacCallum P, Kakkar A, Richard Hobbs FD, Petrou S, Dale J, Poole CJ, Maraveyas A, Levine M (2018) 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 36:2017–2023. https://doi.org/10.1200/JCO.2018.78.8034
doi: 10.1200/JCO.2018.78.8034
Yust-Katz S, Mandel JJ, Wu J, Yuan Y, Webre C, Pawar TA, Lhadha HS, Gilbert MR, Armstrong TS (2015) Venous thromboembolism (VTE) and glioblastoma. J Neurooncol 124:87–94. https://doi.org/10.1007/s11060-015-1805-2
doi: 10.1007/s11060-015-1805-2
pubmed: 25985958