Incidence of thromboembolic events in glioblastoma multiforme: The first Middle Eastern study risk stratifying patients from this region.

Abstract

e14044 Background: Prophylactic anticoagulation for Glioblastoma Multiforme patients remains an area of high controversy with no definite guidelines and with clinical practice recommendations depending mainly on individual center based strategies. Considering that the middle eastern population is known to be associated with increased incidence of thrombophilia due to the high prevalence of factor V R506Q Mutation-Leiden and with no studies reporting incidence of VTE with GBM patients in this region, we aimed to conduct the first middle east based study to see if the incidence of VTE in GBM patient will be higher than the other overall reported incidence worldwide and we looked whether using the Khorana score will be a good predictor for assessing the need for VTE prophylaxis in these patients. Methods: we conducted a retrospective chart review to determine the incidence of initial VTE in GBM patients who received treatment at a tertiary care center in Beirut. Results: The total patient population was 132 with males constituting 71.2% of our population compared to 28.8 % females. Preexisting risk factors included: 34.8 % for hypertension, 65.2% for diabetes, and 25% were smokers, 0.8% had history of thrombophilia, and 7.6% had preexisting episode of VTE while 94% of the population had craniotomy. The incidence of deep vein thrombosis (DVT) was 15.4%, while 7.2 % developed a pulmonary embolism (PE). Recurrent VTEs affected 34.8% of those who had a previous VTE, and 7.4% of patients had the recurrent VTE while they were on anticoagulation. Regarding complications, 7.3% developed bleeding, 66% of those had intracranial bleeding while 33 % had a gastrointestinal bleed. Out of all of those who developed bleeding, only 3.4% were on anticoagulation so anticoagulation was not a major risk factor for bleeding. 57.6% of the patients had a Khorana score of 0, 28.8% had a score of 1,7.6% had a score of 2,1.6% had a score of 3, while 8% had a Khorana score of 4. In our cohort, all patients with a Khorana score of 3 and 4 developed VTE which indicated that this could be used as a risk assessment tool for our GBM patients. Conclusions: In conclusion in our study, with its retrospective limitation, we could not prove that our middle eastern populations, though known to have higher incidence of congenital thrombophilia, is associated with much higher incidence of VTE when compared to many studies involving different populations in the world however our cohort of patients with GBM undergoing craniotomy are still at increased risk of thrombotic events with low risk of bleeding despite anticoagulation and the Khorana score could be a risk stratifying method to help us establish the patients who have the highest risk of developing VTE. Prospective studies involving higher number of patients with thrombophilia testing should be explored to risk stratify our patients.