Practical guidance for direct oral anticoagulant use in the treatment of venous thromboembolism in primary and metastatic brain tumor patients

Surabhi Ranjan; Denise Leung; Ashley P Ghiaseddin; Jennie W Taylor; Mina Lobbous; Andrew Dhawan; Joshua A Budhu; Elizabeth Coffee; Kaitlyn Melnick; Sajeel A Chowdhary; Christine Lu-Emerson; Sylvia C Kurz; Joy E Burke; Keng Lam; Mallika P Patel; Erin M Dunbar; Nimish A Mohile; Katherine B Peters

doi:10.1002/cncr.35220

Practical guidance for direct oral anticoagulant use in the treatment of venous thromboembolism in primary and metastatic brain tumor patients

Cancer. 2024 May 1;130(9):1577-1589. doi: 10.1002/cncr.35220. Epub 2024 Jan 30.

Authors

Surabhi Ranjan¹, Denise Leung², Ashley P Ghiaseddin³, Jennie W Taylor⁴, Mina Lobbous⁵, Andrew Dhawan⁵, Joshua A Budhu⁶, Elizabeth Coffee⁶, Kaitlyn Melnick³, Sajeel A Chowdhary⁷, Christine Lu-Emerson⁸, Sylvia C Kurz⁹, Joy E Burke¹⁰, Keng Lam¹¹, Mallika P Patel¹², Erin M Dunbar¹³, Nimish A Mohile¹⁴, Katherine B Peters¹²

Affiliations

¹ Department of Neurology, Cleveland Clinic Florida, Weston, Florida, USA.
² Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
³ Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
⁴ Department of Neurology, University of California, San Francisco, California, USA.
⁵ Rose Ella Burkhardt Brain Tumor & Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
⁶ Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
⁷ Tampa General Hospital Cancer Institute, Tampa General Hospital, Tampa, Florida, USA.
⁸ Department of Neurology, Maine Medical Center and Maine Health Cancer Care, Portland, Maine, USA.
⁹ Department of Neurology & Interdisciplinary Neuro-Oncology, Hertie Institute for Clinical Brain Research, Eberhard Karls University Tübingen, Tübingen, Germany.
¹⁰ Department of Neurology, Beth Israel Lahey Health, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
¹¹ Department of Neuro-Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
¹² Preston Robert Tisch Brain Tumor Center, Duke University, Durham, North Carolina, USA.
¹³ Piedmont Brain Tumor Center, Atlanta, Georgia, USA.
¹⁴ Department of Neurology, University of Rochester, Rochester, New York, USA.

PMID: 38288941
DOI: 10.1002/cncr.35220

Abstract

Management of venous thromboembolism (VTE) in patients with primary and metastatic brain tumors (BT) is challenging because of the risk of intracranial hemorrhage (ICH). There are no prospective clinical trials evaluating safety and efficacy of direct oral anticoagulants (DOACs), specifically in patients with BT, but they are widely used for VTE in this population. A group of neuro-oncology experts convened to provide practical clinical guidance for the off-label use of DOACs in treating VTE in patients with BT. We searched PubMed for the following terms: BTs, glioma, glioblastoma (GBM), brain metastasis, VTE, heparin, low-molecular-weight heparin (LWMH), DOACs, and ICH. Although prospective clinical trials are needed, the recommendations presented aim to assist clinicians in making informed decisions regarding DOACs for VTE in patients with BT.

Keywords: anticoagulants administration & dosage; anticoagulants adverse effects; brain metastasis; brain neoplasm; direct oral anticoagulants; intracranial hemorrhage; low‐molecular‐weight heparin; malignant glioma; venous thromboembolism.

Publication types

Review

MeSH terms

Administration, Oral
Anticoagulants / adverse effects
Brain Neoplasms* / complications
Brain Neoplasms* / drug therapy
Hemorrhage
Humans
Neoplasm Recurrence, Local / drug therapy
Neoplasms* / drug therapy
Prospective Studies
Venous Thromboembolism* / epidemiology

Substances

Anticoagulants