Intracranial hemorrhage with direct oral anticoagulants in patients with brain tumors
| Autor: | Donna Neuberg, Erik J. Uhlmann, Jeffrey I. Zwicker, Griffin M. Weber, Brian J. Carney, Charlene Mantia, Maneka Puligandla |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.drug_class Brain tumor Administration Oral Low molecular weight heparin 030204 cardiovascular system & hematology Risk Assessment Gastroenterology 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Clinical endpoint medicine Humans Cumulative incidence cardiovascular diseases Aged Retrospective Studies Aged 80 and over Brain Neoplasms business.industry Incidence Incidence (epidemiology) Anticoagulants Venous Thromboembolism Hematology Heparin Low-Molecular-Weight Middle Aged medicine.disease Thrombosis nervous system diseases Treatment Outcome Cohort Female business Intracranial Hemorrhages Cohort study |
| Zdroj: | Journal of Thrombosis and Haemostasis. 17:72-76 |
| ISSN: | 1538-7836 |
| DOI: | 10.1111/jth.14336 |
| Popis: | Essentials Intracranial hemorrhage (ICH) is common in patients with brain tumors. We compared rates of ICH with DOACs and low molecular weight heparin. DOACs were associated with a lower incidence of ICH in primary brain tumors. DOACs appear safe to administer to patients with brain tumors. SUMMARY: Background Direct oral anticoagulants (DOACs) are efficacious in the treatment of cancer-associated thrombosis but are associated with an increased risk of hemorrhage compared with low-molecular-weight heparin in certain malignancies. Whether the DOACs increase the incidence of intracranial hemorrhage (ICH) in patients with brain tumors is not established. Objectives To determine the cumulative incidence of ICH in DOACs compared with Low-molecular-weight heparin (LMWH) in patients with brain tumors and venous thromboembolism. Patients and methods A retrospective comparative cohort study was performed. Radiographic images for all ICH events were reviewed and the primary endpoint was cumulative incidence of ICH at 12 months following initiation of anticoagulation. Results and conclusions A total of 172 patients with brain tumors were evaluated (42 DOAC and 131 LMWH). In the primary brain tumor cohort (n = 67), the cumulative incidence of any ICH was 0% in patients receiving DOACs vs. 36.8% (95% confidence interval [CI], 22.3-51.3%) in those treated with LMWH, with a major ICH incidence of 18.2% (95% CI, 8.4-31.0). In the brain metastases cohort (n = 105), DOACs did not increase the risk of any ICH relative to enoxaparin, with an incidence of 27.8% (95% CI, 5.5-56.7%) compared with 52.9% (95% CI, 37.4-66.2%). Similarly, DOAC did not increase the incidence of major ICH in brain metastases, with a cumulative incidence 11.1% (95% CI, 0.5-40.6%) vs. 17.8% (95% CI, 10.2-27.2%). We conclude that DOACs are not associated with an increased incidence of ICH relative to LMWH in patients with brain metastases or primary brain tumors. |
| Databáze: | OpenAIRE |
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