Olin J W, Young J R, Graor R A, Ruschhaupt W F, Beven E G, Bay J W
Department of Peripheral Vascular Disease, Cleveland Clinic Foundation, OH 44106.
Arch Intern Med. 1987 Dec;147(12):2177-9.
There is a common belief that administration of anticoagulants to patients with brain tumors is contraindicated. Between 1982 and 1986, 50 patients with deep venous thrombosis and pulmonary emboli and brain tumors were examined and treated. Twenty-four patients received an inferior vena cava Greenfield filter and 25 patients were treated with anticoagulants. One patient was terminal and received no therapy. Patients in each group were similar with regard to age, sex, primary tumor, computed tomographic findings, and ultimate outcome. At the time of diagnosis, all patients had residual tumor and most had significant cerebral edema and midline shift. There were no complications in the group receiving Greenfield filters. One patient had a pulmonary embolus after the filter was placed and later required anticoagulant therapy. In the group receiving anticoagulants, one patient had focal intraventricular bleeding observed incidentally on computed tomographic scan one month after beginning anticoagulant therapy and was totally asymptomatic. One patient had gastrointestinal tract bleeding five days after beginning anticoagulant therapy with heparin sodium, and the therapy was therefore discontinued. No other patient had significant bleeding. In view of these findings, a reevaluation of anticoagulant therapy in patients with central nervous system tumors is warranted.
有一种普遍的看法认为，给脑肿瘤患者使用抗凝剂是禁忌的。在1982年至1986年期间，对50例患有深静脉血栓形成、肺栓塞和脑肿瘤的患者进行了检查和治疗。24例患者接受了下腔静脉格林菲尔德滤器植入，25例患者接受了抗凝治疗。1例患者处于终末期，未接受任何治疗。每组患者在年龄、性别、原发肿瘤、计算机断层扫描结果及最终结局方面相似。诊断时，所有患者均有残留肿瘤，大多数患者有明显的脑水肿和中线移位。接受格林菲尔德滤器植入的患者组未出现并发症。1例患者在植入滤器后发生肺栓塞，后来需要抗凝治疗。在接受抗凝治疗的患者组中，1例患者在开始抗凝治疗1个月后，计算机断层扫描偶然发现有局灶性脑室内出血，但完全没有症状。1例患者在开始使用肝素钠进行抗凝治疗5天后出现胃肠道出血，因此停止了治疗。没有其他患者出现严重出血。鉴于这些发现，有必要对中枢神经系统肿瘤患者的抗凝治疗进行重新评估。
