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Heparin-induced tumour bleed.

Venkatesh S Madhugiri¹, Anita Mahadevan, Sudheer Kumar Gundamaneni

¹Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India. venkateshmadhugiri@gmail.com

BMJ Case Reports

|December 15, 2012

Summary

Patients with gliomas face risks of deep vein thrombosis, necessitating pharmacological prophylaxis. However, this must be balanced against the potential for spontaneous hemorrhage from brain tumors, as illustrated by a case study.

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Area of Science:

Neuro-oncology
Vascular Medicine
Clinical Pharmacology

Background:

Patients diagnosed with gliomas are susceptible to deep vein thrombosis (DVT) and other thromboembolic events.
Pharmacological prophylaxis is often considered for these patients to mitigate thrombotic risks.
The decision to initiate prophylaxis requires careful consideration of potential complications, such as spontaneous hemorrhage.

Observation:

A patient with a high-grade glioma presented with hemiparesis.
Heparin prophylaxis was initiated for the patient due to the risk of thromboembolic events.
The patient subsequently experienced a spontaneous tumor bleed.

Findings:

The case highlights the critical need to balance the benefits of pharmacological prophylaxis against the risks of hemorrhage in glioma patients.
Tumor characteristics and patient-specific factors may influence the likelihood of spontaneous bleeding events.
The occurrence of a tumor bleed underscores the complex management challenges in neuro-oncology.

Implications:

Clinical guidelines for DVT prophylaxis in glioma patients may need refinement to incorporate individual risk assessments for hemorrhage.
Further research is warranted to identify predictive markers for hemorrhage risk in patients receiving anticoagulation.
This case emphasizes the importance of multidisciplinary collaboration in managing glioma patients with comorbid thrombotic and bleeding risks.