Safety of long-term anticoagulation in patients with brain metastases

Abstract

Anticoagulation is thought to be associated with the risk of intracranial hemorrhage (ICH) in patients with brain metastases; however, the data on this topic are limited. This study was conducted to determine the incidence of ICH associated with anticoagulant use in adult patients with brain metastases. Consecutive patients with brain metastases occurring from 2006 to 2014 were identified from a single-institution database. Long-term anticoagulant therapy was defined as outpatient anticoagulation therapy of > 1 month. Chi-square tests and Fisher's exact test were used to compare rates of ICH by groups. This cohort included 125 patients with brain metastases. Of these, 64 had primary of non-small cell lung cancer (51.2%). Of these patients, 12/125 (9.6%) patients developed ICH. Neither the primary tumor site nor the number of brain metastases was associated with the development of ICH. ICH incidence was not associated with the use of anticoagulant therapy, with 8/67 (11.94%) patients on outpatient anticoagulation and 4/58 (6.9%) not on anticoagulation experiencing ICH (p = 0.33). The type of treatment did not significantly influence ICH, although those having combined WBRT and SRS were numerically more likely to experience ICH (4/15; 26.67%) of this cohort. In patients on enoxaparin, there was no difference in the incidence of ICH for daily versus twice-daily dosing (p = 1.0). Long-term anticoagulant use is not associated with an increased incidence of ICH in patients with intracranial metastases.

Intracranial Hemorrhage in Patients with Anticoagulant Therapy Undergoing Stereotactic Radiosurgery for Brain Metastases: A Bi-Institutional Analysis

“…The authors found the highest rate of ICH in the patients undergoing WBRT and SRS as opposed to other treatments for BM [36]. The overall low incidence of bleeding events prevented the observation of any statistically significant findings [36]. Our results are supported by the data of Horstmann et al, with comparable frequencies of bleeding events [36].…”

“…Approximately 50% of these patients suffered from primary non-small-cell lung cancer (NSCLC), and a total of twelve ICHs occurred. Of these twelve bleeding events, eight occurred in patients with ACT, and this equated to a non-significant increase compared to the number of events in patients without ACT [36]. The authors found the highest rate of ICH in the patients undergoing WBRT and SRS as opposed to other treatments for BM [36].…”

“…Of these twelve bleeding events, eight occurred in patients with ACT, and this equated to a non-significant increase compared to the number of events in patients without ACT [36]. The authors found the highest rate of ICH in the patients undergoing WBRT and SRS as opposed to other treatments for BM [36]. The overall low incidence of bleeding events prevented the observation of any statistically significant findings [36].…”

“…Given the scarcity of available reports on this matter, we suggest that the use of ACT in these patients is safe. In general, a few studies and a meta-analysis found that there was no dramatically increased ICH risk for patients with BM receiving ACT [30,31,[34][35][36][37][38]. However, some evidence of an increased ICH risk for BM in the case of patients receiving ACT is available as well [39].…”

“…Horstman et al reported on the ICH rates of 125 patients with BM regardless of the treatments used, and included cases with and without ACT [36]. Approximately 50% of these patients suffered from primary non-small-cell lung cancer (NSCLC), and a total of twelve ICHs occurred.…”