Mantia Charlene, Zwicker Jeffrey I
Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
Division of Hemostasis and Thrombosis, Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215, USA.
Cancer Treat Res. 2019;179:179-189. doi: 10.1007/978-3-030-20315-3_12.
Venous thromboembolism is commonly diagnosed in patients with primary and secondary brain tumors. Anticoagulation management in the setting of brain tumors is complicated by the high background rate of spontaneous intracranial hemorrhage. Until recently, there was limited evidence to support the decision to administer therapeutic anticoagulation in the setting of brain metastases or primary brain tumors. The current evidence suggests that the safety profile of therapeutic low molecular weight heparin for the treatment of venous thromboembolism is contingent on whether the origin of brain tumor is primary (i.e., glioma) versus secondary. In patients with brain metastases, the rate of intracranial hemorrhage often exceeds 20% but is not influenced by the administration of low molecular weight heparin. In contrast, in primary brain tumors such as glioma, therapeutic anticoagulation is associated with an increased risk of intracranial hemorrhage that can negatively impact survival. This chapter reviews the underlying mechanisms contributing to thrombosis and hemorrhage in brain tumors and summarizes the current evidence and approaches in anticoagulation to treat venous thromboembolism.
静脉血栓栓塞在原发性和继发性脑肿瘤患者中很常见。脑肿瘤患者的抗凝管理因自发性颅内出血的高背景发生率而变得复杂。直到最近，支持在脑转移瘤或原发性脑肿瘤患者中进行治疗性抗凝的决定的证据还很有限。目前的证据表明，治疗性低分子量肝素治疗静脉血栓栓塞的安全性取决于脑肿瘤的起源是原发性（即胶质瘤）还是继发性。在脑转移瘤患者中，颅内出血的发生率通常超过20%，但不受低分子量肝素给药的影响。相比之下，在原发性脑肿瘤如胶质瘤患者中，治疗性抗凝与颅内出血风险增加相关，这可能对生存产生负面影响。本章回顾了导致脑肿瘤血栓形成和出血的潜在机制，并总结了目前治疗静脉血栓栓塞的抗凝证据和方法。
