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Thromboembolism in brain tumors
1Department of Surgical Oncology, Technology and Intensive Care, Imperial College School of Medicine, Hammersmith Hospital, London W12 0SH, UK.
Current Opinion in Pulmonary Medicine
|October 5, 2001
Summary
Patients with brain tumors face a high risk of venous thromboembolism. Evidence suggests antithrombotic prophylaxis is safe and effective, warranting further study of low molecular weight heparins.
Area of Science:
- Neurology
- Oncology
- Hematology
Background:
- Venous thromboembolism (VTE) is a frequent complication in patients undergoing treatment for primary and secondary cerebral tumors.
- Malignant brain tumors induce a hypercoagulable state, increasing thrombosis risk.
- Neurological deficits are also identified as independent risk factors for thrombosis.
Purpose of the Study:
- To review recent literature on molecular mechanisms of hypercoagulability in brain tumor patients.
- To examine clinical studies on antithrombotic prophylaxis and therapy in this population.
- To assess the safety and efficacy of anticoagulation strategies for VTE prevention and treatment.
Main Methods:
- Computerized MEDLINE database search from 1966 to present.
- Keywords included various brain tumor types (glioma, astrocytoma, glioblastoma multiforme) and VTE-related terms (thromboprophylaxis, heparin, anticoagulants).
- Literature review focused on molecular mechanisms and clinical studies.
Main Results:
- Malignant brain tumors alter blood composition, promoting clotting.
- Concerns regarding perioperative intracranial bleeding with antithrombotic prophylaxis appear unjustified by current evidence.
- Low molecular weight heparins require prospective assessment for prophylaxis and treatment.
- Antithrombotic therapy may be superior to intracaval devices for preventing pulmonary embolism.
Conclusions:
- Antithrombotic prophylaxis is likely safe and beneficial for brain tumor patients at risk of VTE.
- Further prospective studies on low molecular weight heparins are needed.
- Anticoagulation strategies offer potential advantages over mechanical interventions for VTE management in this cohort.
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