NCOG-66. IMPLICATION OF D-DIMER IN THE DETECTION OF DEEP VENOUS THROMBOSIS (DVT) /PULMONARY EMBOLISM (PE) IN HIGH GRADE GLIOMA PATIENTS WITHOUT CLASSIC SYMPTOMS OF DVT/PE ON OR OFF AVASTIN TREATMENT

Abstract

Abstract The incidence of DVT/PE in high grade glioma patients is very high with increased risk of intracranial hemorrhage (ICH) in patients with recent surgery, Avastin and chemotherapy induced thrombocytopenia. We have frequently encountered patients with PE who presented with increased fatigue and somnolence before they developed classic symptoms of PE. It is critical that a high index of suspicion be maintained and patient screened for early detection of PE. A retrospective chart review from June 2015 to May 2020 is being performed on 500 patients with high grade glioma. D-Dimer was used as a screening test for early detection of DVT/PE. Of the 175 patients analyzed 57(32.5 %) patients had DVT/PE, 12 had DVT only and 45 patients had PE with or without DVT. Fatigue which was out of proportion to the expected chemotherapy/radiation side effects was present in 38/45 patients with PE. Classic symptoms of PE were only seen in 10/45 patients. Of 57 patients with DVT/PE with positive D-Dimer 10 asymptomatic patients were on Avastin at the time of diagnosis. The median D Dimer value for 44 positive patients was 2.43 (0.57-23.95).Of the 57 positive patients 52 (91.2%) were treated with full anticoagulation- lovenox (n-35), coumadin (n-8), eliquis (n-7) and xeralto (n-2). The IVC filter was placed in 6 patients.High risk patients were fully anticoagulated for 1-3 months. Patients with resolution of PE/DVT were switched to preventive dose of anticoagulants. Two patients had h/o hypercoagulable disorder. Two patients had symptomatic ICH on lovenox and 1 had asymptomatic sub centimeter ICH on Xeralto. Conclusion- D Dimer is very helpful in the early detection of DVT/PE in high grade glioma patients. Patients with excessive Fatigue and somnolence can be screened for PE using D-Dimer.The D Dimer screening can help with early detection of DVT/PE in patients being treated with Avastin.