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Treatment and prevention of venous thromboembolism in patients with brain tumors

Eudocia Quant Lee, MD, MPH
Patrick Y Wen, MD
Section Editor
Lawrence LK Leung, MD
Deputy Editor
April F Eichler, MD, MPH


Treatment and prevention of venous thromboembolism (VTE) in patients with primary and metastatic brain tumors is complicated by two conflicting issues. Patients with brain tumors have a substantial risk for developing VTE due to a hypercoagulable state, neurosurgical procedures, and often leg paresis. However, there is concern that antithrombotic agents can precipitate hemorrhage into the tumor with neurological worsening.

The balance between these issues is discussed here. The overall risk, diagnosis, and treatment of VTE in patients with malignancy, as well as risk and treatment of anticoagulant-associated intracerebral hemorrhage, are reviewed separately. (See "Treatment of venous thromboembolism in patients with malignancy" and "Risk of intracerebral bleeding in patients treated with anticoagulants" and "Reversal of anticoagulation in warfarin-associated intracerebral hemorrhage".)


Patients with primary or metastatic brain tumors, as well as malignancies at other sites, have a latent hypercoagulable state that predisposes to thromboembolism, particularly in the postoperative period [1-3]. (See "Risk and prevention of venous thromboembolism in adults with cancer" and "Pathogenesis of the hypercoagulable state associated with malignancy".)

Estimates of the incidence of venous thromboembolism (VTE) consistently show increased relative risk among patients with cancer compared with the general population, particularly in patients with glioblastoma [4]. In prospective studies of patients with malignant glioma, the observed incidence of symptomatic VTE ranges from 17 to 26 percent [5-8].

Although there is clustering of venous thromboembolic events in the postoperative period following craniotomy and during intensive chemotherapy, the risk persists throughout the clinical course [3]. Risk factors for venous thromboembolism in brain tumor patients may include age ≥60 years, obesity, glioblastoma histology, large tumor size, subtotal resection, use of steroids, chemotherapy, neurosurgery within the past two months, the presence of leg paresis, and A or AB blood type [2,3,9-12].


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Literature review current through: Sep 2016. | This topic last updated: Aug 31, 2016.
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