Portillo Jose, de la Rocha Iris Violeta, Font Llorenç, Braester Andrei, Madridano Olga, Peromingo José Antonio Díaz, Apollonio Alessandro, Pagán Barbara, Bascuñana José, Monreal Manuel
Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Spain; Facultad de Medicina de Ciudad Real, Universidad de Castilla La Mancha, Spain.
Department of Internal Medicine, Hospital General Universitario de Ciudad Real, Spain.
Thromb Res. 2015 Dec;136(6):1199-203. doi: 10.1016/j.thromres.2015.10.043. Epub 2015 Oct 30.
There is uncertainty about the optimal therapy of venous thromboembolism (VTE) in patients with glioblastoma multiforme (GBM).
We used the RIETE (Registro Informatizado Enfermedad TromboEmbólica) database to compare the rate of VTE recurrences and major bleeding during the course of anticoagulation in patients with GBM, other cancers and in patients without cancer.
As of September 2014, 53,546 patients have been recruited in RIETE. Of these, 72 (0.13%) had GBM and 11,811 (22%) had other cancers. Most patients in all 3 subgroups received initial therapy with low-molecular-weight heparin (LMWH), but those with GBM received slightly lower doses than those with other cancers or without cancer. Then, most patients with GBM continued on LMWH for long-term therapy, at similar doses than those in the other subgroups. During the course of anticoagulation (mean, 202 days), 3 patients with GBM presented VTE recurrences (10.9 per 100 patient-years; 95% CI: 2.76-29.5) and 4 suffered major bleeding (one intracranial) (14.5 bleeds per 100 patient-years; 95%CI: 4.60-34.9). Compared with patients with other cancers, those with GBM had a similar rate of VTE recurrences and major bleeds, but had a higher rate of extracranial hematoma (p<0.05). Compared with VTE patients without cancer, those with GBM had a higher rate of PE recurrences (p<0.01) and major bleeding (p<0.001), particularly extracranial hematoma (p<0.001).
Patients with GBM and VTE had a similar rate of VTE recurrences or major bleeds during the course of anticoagulant therapy than those with other cancers.
多形性胶质母细胞瘤（GBM）患者静脉血栓栓塞症（VTE）的最佳治疗方法尚不确定。
我们使用RIETE（静脉血栓栓塞疾病信息登记库）数据库，比较GBM患者、其他癌症患者和无癌症患者在抗凝治疗过程中VTE复发率和大出血发生率。
截至2014年9月，RIETE共纳入53,546例患者。其中，72例（0.13%）患有GBM，11,811例（22%）患有其他癌症。所有3个亚组中的大多数患者初始治疗采用低分子量肝素（LMWH），但GBM患者的剂量略低于其他癌症患者或无癌症患者。然后，大多数GBM患者继续使用LMWH进行长期治疗，剂量与其他亚组相似。在抗凝治疗过程中（平均202天），3例GBM患者出现VTE复发（每100患者年10.9例；95%CI：2.76 - 29.5），4例发生大出血（1例颅内出血）（每100患者年14.5次出血；95%CI：4.60 - 34.9）。与其他癌症患者相比，GBM患者的VTE复发率和大出血发生率相似，但颅外血肿发生率更高（p<0.05）。与无癌症的VTE患者相比，GBM患者的肺栓塞复发率更高（p<0.01），大出血发生率更高（p<0.001），尤其是颅外血肿（p<0.001）。
GBM合并VTE患者在抗凝治疗过程中VTE复发率或大出血发生率与其他癌症患者相似。
