Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: A case series study

Vitale, Felice Vito; Rotondo, Stefano; Sessa, Edoardo; Parisi, Antonio; Giaimo, Valentina; D’Angelo, Alessandro; Antonelli, Giovanna; Romeo, Placido; Ferraú, Francesco

doi:10.1177/1078155210390254

Cited by 15 publications

(14 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The absence of an effect of low-molecular-weight heparin on rates of intracranial hemorrhage is consistent with the findings of smaller studies, including a case series of 38 patients 15 and a retrospective cohort study of 44 patients with melanoma brain metastases. 7 In the current study, the only covariate that was predictive of hemorrhage was the combined group of renal cell carcinoma and melanoma.…”

Section: Discussionsupporting

confidence: 85%

“…Initial sample size estimates were based on an anticipated rate of intracranial hemorrhage of 7% in the enoxaparin cohort and 2% in the control cohort. 6,7,15 Accordingly, the target analysis was approximately 200 patients treated with enoxaparin and 400 controls (1-sided a of 0.05% and power of 0.85). For the 3 primary bleeding end points, analysis was performed using a competing risk approach to account for death as a competing risk for intracranial hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study

Donato

Campigotto

Uhlmann³

et al. 2015

Blood

144

109

View full text Add to dashboard Cite

• Significant intracranial hemorrhage occurs in 20% to 50% of patients with metastatic brain tumors.• Therapeutic anticoagulation in patients with brain metastasis did not increase the risk for intracranial hemorrhage.Venous thromboembolism occurs frequently in patients with cancer who have brain metastases, but there is limited evidence supporting the safety of therapeutic anticoagulation. To assess the risk for intracranial hemorrhage associated with the administration of therapeutic doses of low-molecular-weight heparin, we performed a matched, retrospective cohort study of 293 patients with cancer with brain metastases (104 with therapeutic enoxaparin and 189 controls). A blinded review of radiographic imaging was performed, and intracranial hemorrhages were categorized as trace, measurable, and significant. There were no differences observed in the cumulative incidence of intracranial hemorrhage at 1 year in the enoxaparin and control cohorts for measurable (19% vs 21%; Gray test, P 5 .97; hazard ratio, 1.02; 90% confidence interval [CI], 0.66-1.59), significant (21% vs 22%; P 5 .87), and total (44% vs 37%; P 5 .13) intracranial hemorrhages. The risk for intracranial hemorrhage was fourfold higher (adjusted hazard ratio, 3.98; 90% CI, 2.41-6.57; P < .001) in patients with melanoma or renal cell carcinoma (N 5 60) than lung cancer (N 5 153), but the risk was not influenced by the administration of enoxaparin. Overall survival was similar for the enoxaparin and control cohorts (8.4 vs 9.7 months; Log-rank, P 5 .65). We conclude that intracranial hemorrhage is frequently observed in patients with brain metastases, but that therapeutic anticoagulation does not increase the risk for intracranial hemorrhage. (Blood. 2015;126(4):494-499)

show abstract

Section: Discussionsupporting

confidence: 85%

Section: Discussionmentioning

confidence: 99%

Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study

Donato

Campigotto

Uhlmann³

et al. 2015

Blood

144

109

View full text Add to dashboard Cite

show abstract

“…Of the 40 patients, 1 developed a dvt while taking tinzaparin, and 3 developed thromboembolic complications while off tinzaparin 58 . Similar findings from retrospective reviews of bleeding events have been reported elsewhere in patients with central nervous system malignancy receiving prophylactic anticoagulation 71,72 .…”

Section: 55supporting

confidence: 74%

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

Easaw

Shea‐Budgell

et al. 2015

Current Oncology

View full text Add to dashboard Cite

Patients with cancer are at increased risk of venous thromboembolism (vte). Anticoagulation therapy has been shown to prevent vte; however, unique clinical circumstances in patients with cancer can often complicate the decisions surrounding the administration of prophylactic anticoagulation. No national Canadian guidelines on the prevention of cancer-associated thrombosis have been published. We therefore aimed to develop a consensus-based, evidence-informed guideline on the topic.PubMed was searched for clinical trials and meta-analyses published between 2002 and 2013. Reference lists of key articles were hand-searched for additional publications. Content experts from across Canada were assembled to review the evidence and make recommendations.Low molecular weight heparin can be used prophylactically in cancer patients at high risk of developing vte. Direct oral anticoagulants are not recommended for vte prophylaxis at this time. Specific clinical scenarios, including renal insufficiency, thrombocytopenia, liver disease, and obesity can warrant modifications in the administration of prophylactic anticoagulant therapy. There is no evidence to support the monitoring of anti–factor Xa levels in clinically stable cancer patients receiving prophylactic anticoagulation; however, factor Xa levels could be checked at baseline and periodically in patients with renal insufficiency. The use of anticoagulation therapy to prolong survival in cancer patients without the presence of risk factors for vte is not recommended.

show abstract

“…In a study with 203 metastatic cancer patients of whom 44 had brain metastases, patients received dalteparin and no increased incidence of a major bleeding episode was observed [130]. In a study by Vitale et al, 26 lung cancer patients with CNS metastases were treated with a LMWH and no patient developed intracranial hemorrhage [131]. Other complications of lung cancer such as hemoptysis should also be taken in consideration.…”

Section: Treatment Of Thrombosismentioning

confidence: 95%

Lung cancer associated venous thromboembolic disease: A comprehensive review

Corrales-Rodriguez¹,

Blais

2012

Lung Cancer

View full text Add to dashboard Cite

Low molecular weight heparin administration in cancer patients with hypercoagulability-related complications and carrying brain metastases: A case series study

Abstract: There is no standard medical approach for the management of patients who require anticoagulant treatment and are suffering from brain MTS. These patients as necessary, might be anticoagulated with LMWH and its dose reduction is to be considered.

Cited by 15 publications

References 42 publications

Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study

Intracranial hemorrhage in patients with brain metastases treated with therapeutic enoxaparin: a matched cohort study

Canadian Consensus Recommendations on the Management of Venous Thromboembolism in Patients with Cancer. Part 1: Prophylaxis

Lung cancer associated venous thromboembolic disease: A comprehensive review

Contact Info

Product

Resources

About