Complications of anticoagulant therapy in patients with brain metastases.

Abstract

2078 Background: Anticoagulation has long been viewed as carrying excessive risk of intracranial hemorrhage (ICH) in patients with brain metastases. However the data evaluating the exact incidence of ICH in patients on anticoagulant therapy (ACT) are sparse. This study was conducted to determine the incidence of ICH associated with ACT in adult patients with brain metastases Methods: Consecutive patients with brain metastases occurring from 2006-2014 were identified from a single institution database. Patients were categorized as having no outpatient anticoagulant therapy versus having outpatient anticoagulation therapy of greater than 1 month. Chi-square tests and Fisher’s exact test were used to compare rates of ICH by groups. Statistical analyses were carried out using SAS 9.3. Results: A total of 125 patients with brain metastases were analyzed. Of these, 64 had primary non-small cell lung cancer (51.2%), while the other primary sites included, breast (12%), melanoma and small cell lung cancer (7.2%) Overall, 12/125 (9.6%) patients had evidence of ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. Eight of 67 (11.94%) patients on outpatient ACT had evidence of ICH, compared with 4 of 58 (6.9%) patients not on ACT; however, this difference was not statistically significant (p = 0.33). In the subset of patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice daily dosing (p = 1.0). Those treated with stereotactic radiosurgery in addition to whole-brain radiotherapy (SRS+WBRT) were significantly more likely to experience ICH (p = 0.0014), however these were within the metastatic lesion and none of these events required any further intervention than ACT cessation. Conclusions: Treatment of metastases with SRS+WBRT was significantly correlated with ICH independent of ACT. Our finding that ACT does not significantly increase risk for ICH supports its use in these patients.