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Thromboembolism in brain tumors.

D C Walsh¹, A K Kakkar

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.

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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.