Thromboembolic Complications

Chapter 12 - Anticoagulation and Management of Seizures and Brain Oedema in Brain Tumour Patients

Risk of venous thromboembolic (VTE) complications such as deep vein thrombosis and pulmonary embolism in patients with primary brain tumours, especially high-grade gliomas, is high, reaching up to 18% per year. 

It depends on patient factors, glioma-associated factors and treatment-related factors.

Proposed risk model for VTE in brain tumour patients:

Risk for VTE is unevenly distributed among glioma patients. This risk assessment model uses only routine laboratory parameters;

  1. Leukocyte count (cutoff ≥11.5 × 109/L)
  2. Platelet count (cutoff <196 × 109/L)
  3. D-dimer (cutoff ≥1.66 μg/mL).

One point was assigned, respectively, according to these cutoffs.

Proposed risk model for VTE in brain tumour patients:

Recommendations for VTE prophylaxis and therapy in brain tumour patients:

Therapeutic efficacy as well as substantially increased risk of intracranial bleeding have to be considered.

As yet, there are no studies on the use of novel oral anticoagulants in brain tumour patients.

Revision Questions

  1. Is the risk of VTE in patients with primary brain tumours high or low?
  2. Define suitable routine laboratory parameters for individual risk assessment of VTE in glioma patients.
  3. What kind of drug therapy is currently used in patients with primary brain tumours with VTE?

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Last update: 18 September 2017