Dana-Farber/Partners CancerCare, Harvard Medical School, Yawkey 10B, 55 Fruit St., Boston, MA, 02114, USA.
University of California, San Francisco Department of Medicine and the VA Medical Center, San Francisco, CA, USA.
J Thromb Thrombolysis. 2017 Oct;44(3):392-398. doi: 10.1007/s11239-017-1536-7.
The risk benefit decision in providing anticoagulation for patients with brain metastases is amongst the most difficult decisions faced by clinicians. The purpose of our study was to evaluate both the risk of intracerebral hemorrhage (ICH) associated with anticoagulation therapy and the effect of anticoagulation on survival in patients with brain metastases and venous thromboembolism (VTE). A systematic review of the literature was performed via the PubMed, EMBASE, and the Cochrane databases. Our initial search resulted in 1304 unique citations, and 5 studies satisfied all eligibility criteria and were included for analysis. The odds ratio for development of ICH in the setting of anticoagulation was 1.37 (CI 0.86-2.17, p = 0.18). The hazard ratio for survival was 0.96 (CI 0.51-1.81, p = 0.90). While limited, the best available evidence suggests that there is no increased risk of ICH and no survival benefit associated with providing anticoagulation to patients with brain metastases who develop VTE. These patients merit individualized discussion of the risk and benefit of anticoagulation therapy. Current guidelines should be updated to include more recent studies and highlight the uncertainty of the net clinical benefit associated with anticoagulation.
为脑转移瘤患者提供抗凝治疗的风险获益决策是临床医生面临的最困难决策之一。我们的研究目的是评估抗凝治疗相关的颅内出血（ICH）风险以及抗凝治疗对脑转移瘤合并静脉血栓栓塞（VTE）患者生存的影响。通过 PubMed、EMBASE 和 Cochrane 数据库进行了系统的文献回顾。我们的初步搜索产生了 1304 个独特的引文，有 5 项研究符合所有入选标准并纳入分析。抗凝治疗时发生 ICH 的优势比为 1.37（95%CI：0.86-2.17，p=0.18）。生存的风险比为 0.96（95%CI：0.51-1.81，p=0.90）。尽管证据有限，但现有的最佳证据表明，对于发生 VTE 的脑转移瘤患者，提供抗凝治疗不会增加 ICH 风险，也不会带来生存获益。这些患者需要个体化讨论抗凝治疗的风险和获益。当前的指南应进行更新，纳入更多最近的研究，并强调与抗凝治疗相关的净临床获益的不确定性。
