Management of venous thromboembolism (VTE) in melanoma patients with brain metastasis

Abstract

9522 Background: Venous thromboembolism (VTE) is a frequent complication in melanoma pts with brain metastases (BM). Because these pts are at very high risk of intracranial bleeding, treating VTE in this population is challenging. Limited data is available regarding the safety of anti-coagulation therapy (TX). Herein we evaluate the clinical outcome of our pts. Methods: Data was collected retrospectively on pts with BM that had deep venous thrombosis (DVT) and/or pulmonary embolism (PE). Eight-one pts were included in the analysis. The purpose of the study was to assess whether TX with anticoagulation would affect the development of hemorrhage post-VTE. Two endpoints are of interest: 1) Overall survival and 2) Development of hemorrhage post-VTE. Cox proportional hazards regression methodology was used for analyses of survival. Analyses of hemorrhage were performed using logistic regression or Fisher’s exact tests. The covariates of interest included VTE therapy (IVC filter vs. anticoagulant vs. both vs. neither), VTE event (DVT vs. PE vs. both), VTE symptoms, DVT location and/or PE, pattern and location of BM (solitary, multiple, hemorrhagic), size of largest BM lesion, co-morbidities, and systemic chemotherapy. Results: 60/81 pts were given anticoagulation. 6/60 pts receiving anticoagulation developed hemorrhage within 1 month (4 intracranial, 1 GI tract, 1 bladder), which was not statistically different from 5 of 21 pts who developed hemorrhage within 1 month in the absence of anticoagulation (3 intracranial, 1 GI tract, 1 adrenal). Of the 6 pts who developed hemorrhage on anticoagulation, 2/6 pts remain alive after 5 and 6 months post VTE and 4 died due to PD. Regimens that included low molecular weight heparin (LMWH) vs. heparin or vitamin K antagonists alone or in combination, showed improved overall survival p=0.033. Hazard ratios (HR) for IVC filter, anticoagulant, and the combination ranged from 0.17 to 0.37. No statistically significant differences in survival were seen between pts treated with anticoagulation alone, IVC filter alone, or the combination of the two. Conclusions: Anticoagulants did not increase the risk of hemorrhage. The presence of BM without evidence of hemorrhage is not a contraindication for the use of anticoagulation therapy. No significant financial relationships to disclose.