Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA.
Best Pract Res Clin Haematol. 2022 Mar;35(1):101350. doi: 10.1016/j.beha.2022.101350. Epub 2022 Jun 12.
Venous thromboembolism (VTE) is a common complication in patients with primary and metastatic brain cancer. Treatment of thrombosis in these patients must be balanced against the risk of intracranial hemorrhage (ICH). A number of cohort studies conducted over the last several years have assessed the risk of ICH in patients with primary or secondary brain tumors in the setting of anticoagulation. Anticoagulation with warfarin or low-molecular weight heparin significantly increases the risk of ICH in the setting of primary brain cancers. In contrast, therapeutic anticoagulation does not appear to alter the risk of ICH among patients with metastatic brain tumors. This review summarizes current data regarding anticoagulant and antiplatelet therapy in patients with brain tumors, including emerging data on direct-acting oral anticoagulants, and other related topics, such as the use of inferior vena cava filters and resumption of anticoagulation following ICH.
静脉血栓栓塞症（VTE）是原发性和转移性脑癌患者的常见并发症。这些患者的血栓治疗必须平衡颅内出血（ICH）的风险。过去几年进行的多项队列研究评估了原发性或继发性脑肿瘤患者在抗凝治疗情况下发生 ICH 的风险。华法林或低分子量肝素抗凝显著增加原发性脑癌患者发生 ICH 的风险。相比之下，治疗性抗凝似乎不会改变转移性脑肿瘤患者发生 ICH 的风险。这篇综述总结了关于脑肿瘤患者抗凝和抗血小板治疗的现有数据，包括直接作用口服抗凝剂的新数据，以及其他相关主题，如下腔静脉滤器的使用和 ICH 后抗凝的恢复。
