Abstract
Patients with primary and metastatic brain tumors are predisposed to thromboembolism. This review of the literature explores the high prevalence of venous thromboembolism and its negative impact on patients with brain cancer. It outlines the recommended prophylactic strategies to prevent venous thrombosis and analyzes the benefit versus risk of anticoagulation in this population, with a focus on the risk of intracranial bleeding associated with it. Additionally, it explores the exceedingly high prevalence of venous thromboembolism in the setting of brain cancer surgeries and provides guidance on the best methods used for prophylaxis in this setting and discusses the safety of each method perioperatively. Lastly, this review article provides guidance on how to manage venous thromboembolism in patients with brain cancer and discusses the use of vena cava filters in this population.
Highlights
Brain tumors represent a diverse group of neoplasms classified into either primary brain tumors, which originate from within the central nervous system (CNS), or secondary brain tumors, which are spread from a tumor elsewhere in the body
Cancer patients in general are at significantly increased risk of developing venous thromboembolism (VTE) [1,2]
1.3% developed an Intracranial hemorrhage (ICH) requiring surgical evacuation at a median of two days after surgery. These findings suggest an increased risk of VTE beyond the period of hospitalization, whereas ICH occurs predominantly within the first few days after surgery [23]
Summary
Brain tumors represent a diverse group of neoplasms classified into either primary brain tumors, which originate from within the central nervous system (CNS), or secondary brain tumors (metastatic), which are spread from a tumor elsewhere in the body. Given the literature available to date, the use of prophylactic or even therapeutic anticoagulation does not seem to increase the risk of major intracranial bleeding in patients with brain cancer. Authors of other studies reported similar results, prophylactic heparin administered perioperatively for neurosurgical patients is safe to use These studies focused on the general population of neurosurgery patients and were not restricted to patients with brain tumors undergoing craniotomy [25,26]. The most updated American Society of Clinical Oncology (ASCO) practice guidelines recommend anticoagulation for patients with primary or metastatic brain malignancies and an established VTE This is based on a large systematic review that included a total of 35 publications (26 meta-analyses and nine randomized controlled trials) on VTE conducted by Key et al [32]. It may be offered to patients with absolute contraindications to anticoagulant therapy in the acute treatment setting if the thrombus burden is considered life-threatening [32]
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