Nghiemphu Phioanh Leia, Green Richard M, Pope Whitney B, Lai Albert, Cloughesy Timothy F
Department of Neurology, David Geffen School of Medicine at UCLA, 710 Westwood Plaza, RNRC 1-230, Los Angeles, CA 90095, USA.
Neuro Oncol. 2008 Jun;10(3):355-60. doi: 10.1215/15228517-2008-009. Epub 2008 Apr 24.
Bevacizumab in combination with chemotherapy is now being studied for the treatment of malignant gliomas. However, the risk of intracranial hemorrhage has limited its use in patients requiring full anticoagulation for venous thrombosis. To assess the safety of using anticoagulation with bevacizumab, we conducted a retrospective review of our patients who were treated with bevacizumab while receiving anticoagulation. We reviewed their medical records and imaging for signs of hemorrhage. In total, we had 21 patients who received anticoagulation and bevacizumab concurrently for a median time of 72 days. Eighteen patients had adequate anticoagulation for venous thrombosis. There were no frank lobar hemorrhages in any patient. Three patients had small, intraparenchymal hemorrhages on MRI, but only one patient actually developed symptoms due to the hemorrhage. None of these patients had residual neurological deficits from the hemorrhages. Two more patients had evidence of a minor increase in signal on noncontrast T1-weighted sequence, presumed to be petechial hemorrhages, without any clinical sequelae or progression. In contrast, seven patients who had symptomatic hemorrhages from bevacizumab were not on any anticoagulation. In this retrospective review, anticoagulation did not lead to any major hemorrhages and does not appear to be a contraindication for starting bevacizumab therapy.
贝伐单抗联合化疗目前正在用于恶性胶质瘤治疗的研究中。然而，颅内出血风险限制了其在因静脉血栓形成需要充分抗凝治疗的患者中的应用。为评估贝伐单抗联合抗凝治疗的安全性，我们对接受贝伐单抗治疗同时接受抗凝治疗的患者进行了一项回顾性研究。我们查阅了他们的病历和影像学资料以寻找出血迹象。共有21例患者同时接受了抗凝治疗和贝伐单抗治疗，中位时间为72天。18例患者因静脉血栓形成接受了充分的抗凝治疗。所有患者均未出现明显的脑叶出血。3例患者MRI显示有小的脑实质内出血，但只有1例患者因出血实际出现了症状。这些患者均未因出血遗留神经功能缺损。另有2例患者在非增强T1加权序列上信号轻微增加，推测为瘀点样出血，未出现任何临床后遗症或病情进展。相比之下，7例因贝伐单抗出现症状性出血的患者未接受任何抗凝治疗。在这项回顾性研究中，抗凝治疗未导致任何严重出血，似乎也不是开始贝伐单抗治疗的禁忌证。
