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Poster Display session 1

3882 - Venous Thromboembolism and Intracranial Hemorrhage in Patients with High-grade Glioma


28 Sep 2019


Poster Display session 1


Tumour Site

Central Nervous System Malignancies


Clara Borges


Annals of Oncology (2019) 30 (suppl_5): v143-v158. 10.1093/annonc/mdz243


C. Borges1, J. Simões1, J. Reis1, I. Costa1, C. Lemos2, P. Soares3, R. Silva4, B. Carvalho5, C. Fernandes1, A. Costa1, C. Caeiro1, C. Sarmento1

Author affiliations

  • 1 Medical Oncology, Centro Hospitalar Universitário de São João, EPE, 4200-319 - Porto/PT
  • 2 Mathematics, Polytechnic Institute of Viseu, 3500 - Viseu/PT
  • 3 Radiation Oncology, Centro Hospitalar Universitário de São João, EPE, 4200-319 - Porto/PT
  • 4 Anatomical Pathology, Centro Hospitalar Universitário de São João, EPE, 4200-319 - Porto/PT
  • 5 Neurosurgery, Centro Hospitalar Universitário de São João, EPE, 4200-319 - Porto/PT


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Abstract 3882


Patients with high-grade glioma (HGG) are at increased risk of venous thromboembolism (VTE), throughout the course of disease. Prophylactic anticoagulation is not established outside of perioperative context, due to potential for intracranial hemorrhage (ICH) and the limited data available for predictive VTE scores. Our study aims to characterize VTE risk and assess anticoagulation safety in HGG.


Retrospective analysis of adult patients with HGG diagnosis, proposed to systemic treatment between 2009 and 2018. Exclusion criteria was anticoagulation previous to diagnosis. VTE was defined as radiographic-confirmed thrombus in venous system. Risk factors for VTE and ICH were analyzed by chi-squared test and multivariate logistic regression; survival analysis by Kaplan-Meier method.


Of 410 patients, 31 (7,8%) developed a VTE, including 22 deep, 6 pulmonary and 3 central vein thrombosis. Twenty-nine patients with VTE had WHO grade 4 glioma and 2 patients had grade 3 (anaplastic astrocytoma and oligodendroglioma). In 22 cases, the VTE occurred during systemic treatment, more frequently during Temozolomide (n = 15), followed by Irinotecan+Bevacizumab (n = 6). The median time to VTE was 10,11 months. Khorana score, age, ECOG performance status, smoking and obesity did not significantly differ in the VTE population. All VTE were initially treated with low molecular weight heparin (LMWH), of which 64.5% maintained LMWH, and the remainder switched to warfarin (19.4%) or to direct oral anticoagulant (16.1%). Six patients (19,4%) had spontaneous ICH under anticoagulation. Patients with grade 3 glioma (p = 0,032) had significantly higher rates of ICH. Patients with higher ECOG had significantly higher risk of ICH (OR 3,23 (95CI 1,18-8,81), p = 0,022). HAS-BLED and ACCP bleeding scores were not associated with ICH. There was no significant difference in overall survival for TVE or ICH.


According to our data, ICH occurred in nearly 20% anticoagulated patients with HGG, as described in literature, and did not correlate with poorer prognosis. High ECOG performance status was an independent risk factor for ICH. Further effort towards better prediction models for VTE and ICH in HGG is warranted.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.


Has not received any funding.


All authors have declared no conflicts of interest.

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