Anticoagulation of malignant glioma patients in the era of novel antiangiogenic agents

Abstract

Venous thromboembolism (VTE) is common in patients with brain tumors. Anticoagulant therapy is feared due to the risk of bleeding, especially intracranial hemorrhage. Emerging treatment approaches targeting angiogenesis, may increase the risk of both thrombosis and bleeding. Recent advances in the cause, prevention, and treatment of VTE in brain tumor patients in the era of antiangiogenic therapy are reviewed. About 20-30% of malignant glioma patients develop clinically significant thromboembolism; however, a recent randomized trial suggested increased intracranial bleeding with the use of prophylactic anticoagulation. Antiangiogenic therapies, especially those targeting vascular endothelial growth factor or its receptor, may increase the risk of thrombosis. New data regarding the safety of anticoagulation concurrent with bevacizumab have emerged. VTE is common perioperatively and throughout the course of brain tumor therapy. Therapeutic anticoagulation followed by secondary anticoagulant thromboprophylaxis is indicated in most patients with DVT or pulmonary embolism, including patients receiving antiangiogenic agents. The role of primary antithrombotic prophylaxis remains unclear.