Abstract
Cancer is an independent risk factor for the development of venous thromboembolism (VTE). Glioblastomas are amongst cancer types with the most thrombogenic potential and patients are at a particularly high risk of VTE with an incidence up to 20–30% per year. Currently, major efforts are underway to gain novel insights into risk factors and pathomechanisms to provide a better understanding of development of VTE in patients with primary brain tumors. Treatment of VTE requires therapeutic anticoagulation, which accordingly to recently-published guidelines should be performed using low molecular weight heparin or, in case of low bleeding risk, using a direct oral anticoagulant. However, this can be very challenging due to an increased risk of intracranial hemorrhage in this patient group. Furthermore, limited data are available on the subgroup of patients with primary brain tumors.
Highlights
Cancer is an independent risk factor for the development of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, and leads to a four-fold increase in the risk of VTE in this patient group [1]
The study conducted by Unruh et al found an association between a lower risk of VTE and the isocitrate dehydrogenase 1 (IDH1) mutation in patients with glioblastoma, which was confirmed in an analysis of the Vienna Cancer and Thrombosis Study (CATS) trial [20,21]
The incidence of VTE was higher in patients in the placebo group (HR 0.51; 95% CI 0.19–1.4; p = 0.29), but the incidence of major bleeds was increased in the low-molecular-weight heparin (LMWH) group (HR 4.2; 95% CI 0.48–36; p = 0.22)
Summary
Cancer is an independent risk factor for the development of venous thromboembolism (VTE), including deep vein thrombosis and pulmonary embolism, and leads to a four-fold increase in the risk of VTE in this patient group [1]. Depending on the cancer site, primary brain tumors, especially glioblastoma, belong to the group of cancer types with the most thrombogenic potential. An association with the 1-year relative mortality can be clearly seen between the biological aggressiveness of the cancer and its thrombogenic potential [3,4,5,6,7]. In this patient group, VTE is a leading cause of death and patients with VTE have a higher mortality than those without. VTE [8,9]
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